On August 1, 2018, the Bacolod Our Lady of Mercy Specialty Hospital (BOLMSH) closed its operations allegedly due to PhilHealth's denial of its accreditation.
The closure of BOLMSH is a decision that was made by its own Management and not by PhilHealth nor of the Government.
It can continue to exist and operate to serve its local constituencies and for the welfare of its employees if it wants to, even without its accreditation with PhilHealth.
The denial of their application for continuous accreditation filed on January 30, 2018 stemmed from the fact that the hospital has been convicted twice for committing fraudulent acts which involve padding of claims, misrepresentation by furnishing false or incorrect information, and breach of warranties of accreditation/performance commitment as provided for in Sections 154, 158 and 164, respectively, in the Revised Implementing Rules and Regulations (RIRR) of Republic Act 7875, as amended.
Local reports have alleged that PhilHealth had committed an error by attributing these convictions committed by its former Management Tiong Bi Inc. with the current Management Negros Healthcare Management Systems, Inc. (NHMSI).
Regardless if such violations are of the old or of the new Management, Section 63.d of the same RIRR of RA 7875, as amended clearly states that "Change in ownership, management or any form of transfer either by lease, mortgage, or any other transfer of a health care institution without prior notice to the Corporation" is enough ground for PhilHealth to uphold the decision of its Accreditation Committee.
The said Committee is a collegial body that is made up of PhilHealth, Department of Health, Philippine Hospital Association, and Philippine Medical Association, and its decision on this issue is arrived at through a diligent process which is in accordance with the following:
• Section 31, Article VIII of RA 7875, as amended which states that “The Corporation shall have the authority to grant to health care providers accreditation which confers the privilege of participating in the Program”;
• Section 59.f of RIRR, RA 7875, as amended which states that PhilHealth "...reserves the right to issue, deny or withdraw the accreditation after an evaluation of the capability and integrity of the health care institution,”;
• Section 63.c of RIRR, RA 7875, as amended which states that as a ground for denial of accreditation... "Conviction due to fraudulent acts as determined by the Corporation until such time that the decision is reversed by the Appellate Court or the penalty has been fully served"; and
• Provision 8 of their performance commitment which states that “...any change in ownership and/or management of our institution shall not operate to exempt the previous and/or present owner and/or manager from liabilities for violations of RA 7875, as amended, and its IRR.”.
The hospital through its Management NHMSI cannot evade liability on the ground that the violations were committed by previous Management, Tiong Bi Inc.
Once health care institutions partner with PhilHealth for the implementation of the National Health Insurance Program, they commit to abide by the policies that PhilHealth institutes, and any violation of this commitment may be considered as grounds for the non-renewal of their accreditation.
The public also has the right to know that the BOLMSH appeared to have tried deceiving PhilHealth when it submitted its application for continuing accreditation in January 30, 2018 with Dr. Jeremias Manuel K. Moscardon, Jr. as Medical Director; Tiong Bi, Inc. as owner; and managed by NHMSI. On February 7, 2018, another hospital by the name of Holy Mother of Mercy Hospital in Kabankalan in Negros Occidental also submitted its application for continuous accreditation with the same medical director and this time with NHMSI as owner.
Your PhilHealth is duty bound to ensure that the National Health Insurance Program and the millions of Filipinos who rely on the Program for their health insurance needs are protected from unlawful and fraudulent deeds of both its implementers and beneficiaries.
With the best interest of the Filipino in mind, PhilHealth ensures to continue to work for the fund's long-term strength and viability and to continuously grant financial access to quality medical care from its partner health care providers. (END)