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PhilHealth can penalize firms, DOJ legal opinion says

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The Department of Justice (DOJ) took a legal position that the Philippine Health Insurance Corporation (PhilHealth) can still impose penalties against erring health care providers under the National Health Insurance Act of 1995 as long as these offenses were committed before the Universal Health Care Act was signed into law in 2019.

“To repeat, as a rule, all laws are prospective in application unless the contrary is expressly provided, or unless the law is procedural or curative in nature,” DOJ Secretary Jesus Crispin Remulla declared, in a legal opinion dated January 30, 2023, which was sought by PhilHealth Officer-In-Charge President and Chief Executive Officer (CEO) Eli Dino Santos.

Santos inquired if PhilHealth can still revoke the accreditation of health care providers for violating Republic Act No. 7875, the National Health Insurance Act of 1995, even if the resolutions for infractions committed under RA 7875 were issued after the passage of RA 11223, the Universal Health Care Act.

“RA No. 7875 and all its amendatory laws did not provide that they should be applied retrospectively, thus, the general rule that they are prospective in application applies,” Remulla stressed.

This means that “the penalties to be imposed are the prescribed penalties provided under the prior rules, and, hence, the penal provision of Section 38(b) of RA No. 11223 cannot be given retroactive application,” Remulla said.

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Santos also asked Remulla if PhilHealth can still lift revocations of accreditations against health care providers since RA 11223 has “no provision regarding the procedure for accreditation” unlike RA 7875.

Remulla said “both RA No. 7875, as amended, and RA No. 11223 explicitly state that recidivists may no longer be accredited or contracted as participants of the Program.”

He said that “the agency is expressly authorized by law ‘to suspend, revoke permanently, or restore the accreditation of a health care provider,’ may lift the penalty of revocation of accreditation imposed upon the respondent health care provider, if based on its assessment the erring health care provider has already faithfully complied with all its requirements and guidelines.”

“In short, the PhilHealth has the discretion to permanently revoke the accreditation of a health care provider or to restore its accreditation, depending on its findings and assessment,” the DOJ chief declared.

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