NBI files charges against PHILHEALTH Officials

The National Bureau of Investigation-Anti-Graft Division (NBI-AGD) has filed charges before the Office of the Ombudsman against officers of PhilHealth Regional Office – National Capital Region (PRO-NCR) Accreditation Committee in relation to Health Care Provider (HCP) accreditation renewal.

NBI Officer-In-Charge (OIC) Eric B. Distor identified the PRO-NCR officials and personnel as DR. NENITA EPIFANIA F. BALBUENA, DR. IMELDA TRINIDAD DE VERA-PE, JANICE GEM P. PERLAS, MD, ROFIEN H. ISON, MD, DIODE G. LANTORA, ATTY. YASSER ISMAIL A. ABBAS, ALLAN M. DE VILLA, ALEJANDRINO T. PEREZ, MD, JEFFREY Y. PE, DENNIS S. MAS, and DR. CELSTINA MA. JUDE P. DELA SERNA.

OIC Director Distor said that in October 2016, the complainant received a letter from DENNIS S. MAS, Vice President of PRO-NCR informing her that her application for reaccreditation was denied by PRO-NCR Accreditation Sub-Committee from July 1, 2016 to June 4, 2019 due to practice inconsistent with the acceptable quality of care.

In May 2017, complainant, through Atty. Paulo S. Selva, requested the NBI to conduct an investigation on the alleged injustice committed by PRO-NCR officials on the HCP reaccreditation. But in July 2017, complainant withdrew her complaint as she received verbal advice from DR. CELSTINA MA. JUDE P. DELA SERNA, former Interim/Officer-In-Charge, President and CEO PHIC that she will be accredited as HCP if she withdrew her complaint in NBI.

However, in September 2020, complainant requested for revival of the case as the reaccreditation did not push through.

The notice of denial was dated October 13, 2016 but the Accreditation Sub-Committee denial order was ante-dated from July 1 2016 to June 4, 2019. Minutes of Accreditation Sub-Committee Meeting PRO-NCR dated October 10, 2016 was deliberated, approved, and signed by the Sub-Committee NCR Members DR. NENITA EPIFANIA F. BALBUENA (Chairperson), DR. IMELDA TRINIDAD DE VERA-PE, JANICE GEM P. PERLAS, MD, ROFIEN H. ISON, MD, DIODE G. LANTORA, ATTY. YASSER ISMAIL A. ABBAS, ALLAN M. DE VILLA, ALEJANDRINO T. PEREZ, MD, and JEFFREY Y. PE. It shows that the denial was August 3, 2016.

According to PHIC, the denial is due to the administrative case filed against the complainant with the Prosecution Department of PHIC. Complainant, however claimed that she was denied of due process guaranteed under National Health Insurance Act of 1995, the grounds used for the denial was not explained well and there were no specifics given.

She was not also informed or notified of any inquiry or validations made by the PHIC. Further, PHIC was not able to resolve the allegations against her after serving the suspension from July 2016 to June 2019.

Looking at the circumstances on how the renewal of accreditation was denied, it appears that the Accreditation Sub-Committee agreed to reopen the deliberation on the application for accreditation and unanimously voted to recommend the denial of application for accreditation. Also, at the time the denial was made, there was no pending case filed against the complainant.

Further investigation conducted reveals that the basis of denying the application for accreditation was not sufficiently established by PhilHealth. PhilHealth’s authority to deny accreditation of complainant requires that the applicant be first convicted to fraudulent acts. From the records, it appears that complainant was denied of her accreditation even before the case was heard by the Arbitration Office and without a formal complaint and an effort to conduct a fact-finding investigation as mandated by NHI Law.

While it is within the PhilHealth’s power to suspend, revoke, or refuse Accreditation, it must be emphasized that the power to suspend or revoke is exercised based on the existence of grounds and must be compliant with law governing the same. The PhilHealth must observe due process in that it must afford the applicant notice and opportunity to be heard.

DENNIS S. MAS, and DR. CELSTINA MA. JUDE P. DELA SERNA, as Vice President of PRO-NCR and PCEO of PhilHealth respectively, they are presumed to know all existing policies, guidelines, and procedures in carrying out the agency’s mandate. DELA SERNA also acted in bad faith when she promised to reaccredit complainant if she withdrew her complaint at NBI.

NBI-AGD then recommended that above-mentioned Subjects be prosecuted for violation of Section 3(e) of RA 3019 (Anti-Graft and Corrupt Practices Act). Subjects were also recommended to be administratively charged for violation of RA 6713 (Code of Conduct and Ethical Standards for Public Officials and Employees).