CA to medical practitioners: Don’t engage in unethical practices to dupe PhilHealth

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CA to medical practitioners: Don’t engage in unethical practices to dupe PhilHealth
The Court of Appeals also reminds PhilHealth members and officials in a recent ruling 'to act with prudence and without any corrupt motives' in performing their duties

MANILA, Philippines – The Court of Appeals (CA) told healthcare institutions and medical practitioners not to engage in illegal activities in order to take advantage of benefits being offered by the Philippine Health Insurance Corporation (PhilHealth).

The CA’s 5th Division made the reminder in an 11-page decision that denied Dr. Albert Castro’s plea to set aside a PhilHealth board decision that found him liable for the anomalous recruitment of patients for cataract operations.

Claims with PhilHealth made by Castro and several other doctors were suspended following a recommendation by PhilHealth’s legal services unit head Yasser Ismael Abbas, who looked into operations at the Quezon City Eye Center and found irregularities. Abbas’ findings were confirmed by the state health insurer’s Fact-Finding Investigation and Enforcement Department.

“Medical practitioners should not allow themselves to be drawn into this unethical practice,” the appellate court said.

In making the ruling, the CA upheld a guilty verdict by the PhilHealth board against Castro for 17 counts of the administrative offense of breach of warranties of accreditation under Republic Act No. 7875 or the National Health Insurance Act.

Castro previously maintained innocence, arguing that the supposed recruitment activities that PhilHealth found anomalous were initiated by the Bulacan provincial government.

PhilHealth, however, was not convinced, as it found suspicious the free transport of patients from and to the Quezon City Eye Center, when operations could have been performed in government hospitals in Bulacan.

The appellate court also reminded Philhealth officials “to act with prudence and without any corrupt motives” following the incident.

“The present pandemic already highlighted the anomalies, flaws, and limitations of our public health system. PhilHealth’s financial resources, and that of our nation as a whole, are already stretched to its limit. The present situation should inspire us to rise above ourselves and focus on our nation’s survival as a whole,” the CA noted. –

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