PhilHealth accreditation stays but fines imposed on erring hospitals

Published September 16, 2018, 4:12 PM

by Francine Ciasico

By Analou De Vera

The Philippine Health Insurance Corporation (PhilHealth) said it will impose fines on erring hospitals instead of outright suspension or revocation of their accreditation.


The state agency said they have the ability to impose “maximum fines on hospitals liable for offenses in administrative cases with PhilHealth” in accordance to its Board Resolution No. 2334, series of 2017, and its implementing guidelines as contained in Corporate Order 2018-0039.

The agency said that with the said policy, it will keep its commitment to curb fraud and protect its fund from abuse and pilferage without interrupting access to health care services.

“We recognize that suspending or revoking a hospital’s accreditation will result to members not being able to avail of their benefits when they or their dependents are admitted in these facilities,” said PhilHealth acting president Dr. Roy Ferrer in a statement.

PhilHealth stated they have at least “71 hospitals nationwide with a combined total of 298 cases currently in arbitration due to various violations such as fraudulent acts and breach of warranties of accreditation/performance commitment, filing of multiple claims, misrepresentation by furnishing false or incorrect information, and claiming for non-admitted patients, among others.”

However, the agency clarified that the policy of imposing maximum fine does not apply to cases against health care professionals, cataract cases through recruitment schemes, cases that are already on appeal with the courts, and to recidivists or those who have been repeatedly sanctioned for the same offense.

“We are not prevented from suspending or revoking hospital accreditation if truly warranted by circumstances,” Ferrer said.

Ferrer said that from 2010 up to the present, PhilHealth have suspended at least 31 hospitals and “revoked the accreditation of another two facilities” for violations — which include extending period of confinement, misrepresentation, and claiming for non-admitted patients.