By Jenny Ortuoste
The Supreme Court recently declared final and executory their July 2019 decision in favor of an ophthalmologist whose accreditation as a healthcare professional was illegally suspended by the Philippine Health Insurance Corp. (Philhealth).
Supreme Court (MANILA BULLETIN)
The SC’s resolution reads, in part: "In this petition for review on certiorari filed by Dr. Mario D. Reyes, M.D. (Dr. Reyes), we remind Philippine Health Insurance Corporation (PhilHealth) that it cannot impose any penalty beyond what is provided for under the law.”
In 2014, Philhealth, the government agency implementing universal health coverage in the country, unlawfully suspended Reyes’ accreditation for 12 years, from Dec. 1, 2014, to Nov. 30, 2026.
When he was suspended by Philhealth, Reyes was chairman of the Ospital ng Maynila Ophthalmology Department. Philhealth based their suspension on allegations made in a letter of the Philippine Academy of Ophthalmology (PAO).
Reyes asked Philhealth’s then-Board of Directors to reconsider the 12-year suspension imposed upon him, but was denied.
He then filed a case before the Court of Appeals (CA). His lawyer, Saul Hofileña Jr., a former law dean and now a professor of law at the San Beda University College of Law, argued that the suspension was illegal and that Philhealth did not give Reyes the right to be heard.
The CA dismissed Reyes’ petition for review, prompting Reyes and Hofileña to elevate the case to the SC.
In July 2019, the SC declared illegal Philhealth’s imposition of a 12-year suspension against Reyes.
The dispositive part of their resolution grants Reyes’ petition for review on certiorari and reversed and set aside the August 2018 decision of the Court of Appeals.
In their resolution, the SC reminded Philhealth that it is the government, specifically the Board of Medical Examiners, that determines who may practice medicine and not PAO, and therefore Philhealth should not have adopted in toto PAO’s suspension of Reyes.
“There was no showing that Dr. Reyes’ certificate of registration to practice medicine was suspended or revoked by the Board of Medical Examiners,” the SC resolution reads.
According to Hofileña, the 12-year suspension imposed by Philhealth’s previous Board was wrong and without basis in law.
“Philhealth should not take the recommendations of medical organizations blindly,” he said.
The lawyer explained that the findings of PAO were made without giving Reyes the opportunity to explain his side. The former Philhealth Board, he said, should have conducted its own independent investigation and they should have studied the pertinent provisions of the law so that the powers of government will not be abused.
“A quasi-judicial body should have a clear grasp of the law in order to avoid injustice. This case has reached the appellate courts, and private resources and government time have been wasted,” Hofileña said.
“If the people on the former Philhealth Board only knew the law, this case should have been avoided. Now the decision is final and the Supreme Court has put an end to the travails of Dr. Mario Reyes,” he added.
The SC’s resolution is another rebuke to the previous Philhealth administration that came under fire earlier this year for alleged overpayments on health insurance claims amounting to some P154 billion over the past six years.
Some of that amount reportedly went to pay for ‘ghost’ dialysis treatments, padded receipts, and other fraudulent claims.
At the time, President Rodrigo Duterte ordered the National Bureau of Investigation to look into the issue of the filing of fraudulent claims.
Reyes, a devout Roman Catholic and member of a religious community, conducts medical missions in Cebu and Bohol, providing free cataract surgery and other eye treatments to indigent patients.