The Philippine Health Insurance Corporation (PhilHealth) imposed a three-month suspension of the accreditation of Borja Family Hospital located in Tagbilaran City, a press release from the said agency says.
Borja Family Hospital is “adjudged guilty and liable of administrative offense of extending period of confinement under Section 142, Rule XXVIII of the 2001 [implementing rules and regulation] IRR of Republic Act No. 7875 in relation to PhilHealth Circular No. 14, s.2010 (Order Of Discharge), and is accordingly meted the penalty of suspension of three (3) months of its accreditation,” with a fine of P 10,000.
PhilHealth filed a case against the hospital in 2014 after its Regional Legal Office found out, through a hospital inspection, that there was inconsistency in the claim filed by Borja Family Hospital for a patient’s confinement dated February 8 to 24, 2011.
It was noted by the investigating team that the date of discharge indicated in the claim form is incongruous with the “May Go Home” order on the Physician’s Order Sheet which was dated February 21, 2011.
The inconsistency was in violation of Circular No. 14, s. 2010.
Borja Family Hospital filed appeals to the PhilHealth Board but were denied by the governing body; and petition for review and motion for reconsideration at the Court of Appeals which were all subsequently denied in 2016 and 2017. It further filed its petition with the Supreme Court, but the highest court resolved to deny the said petition.
The three-month suspension of the accreditation of the hospital took effect on June 1, 2021 until August 29, 2021.
During this period, PhilHealth will not receive, process, nor pay any claims from Borja Family Hospital, the press release adds.
Members are advised to seek medical services in other health care institution in the area, the Philhealth said in its press release.
In a telephone interview on Wednesday, June 2, 2021, Juvy Ochea, the secretary to the medical director of Borja Family Hospital, confirmed to The Bohol Tribune that the Philhealth suspended the said hospital’s accreditation.
She said that the hospital maintains its innocence and has no malicious intent as alleged by Philhealth.
Ochea said that the hospital remains open and will still serve its clientele even if its Philhealth accreditation is suspended and will be working with patients to cushion the impact on the hospital bills affected with the lack of accreditation.