FIRST DIVISION
[G.R. No. 241062. July 30, 2019.]
DR. MARIO D. REYES, M.D., petitioner, vs.PHILIPPINE HEALTH INSURANCE CORPORATION, respondent.
NOTICE
Sirs/Mesdames :
Please take notice that the Court, First Division, issued a Resolution dated July 30, 2019which reads as follows:
"G.R. No. 241062 (Dr. Mario D. Reyes, M.D. v. Philippine Health Insurance Corporation). — In this petition for review on certiorari 1 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.
On September 12, 2014, the Accreditation Department of PhilHealth (Accreditation Department) received a letter from the Philippine Academy of Ophthalmology (PAO) finding Dr. Reyes accountable for transgressing pertinent provisions of the PAO Code of Ethics and Code of Professional Conduct, the Philippine Medical Association (PMA) Code of Ethics, and the PAO's Statement on Core Values. 2 Thus, the PAO imposed the corresponding sanctions on Dr. Reyes, to wit:
1) Termination of his membership in the PAO for acts of dishonesty when he converted Ospital ng Maynila Charity PHIC [PhilHealth] cataract surgery patients to Pay patients AND when he committed fraud upon the PHIC by receiving PHIC professional fee reimbursements as surgeon for the above cases even though the surgeries were performed by others.
2) Suspension of his membership in the PAO for six (6) years for Uncoordinated Missions.
3) Suspension of his membership in the PAO for an additional six (6) years for Compromising Patient Safety during the missions.
4) Censure for Abuse of Authority when he was the Chairman of the Department of Ophthalmology of the Ospital ng Maynila Medical Center. 3
On the basis of this letter, the Accreditation Department suspended Dr. Reyes' accreditation as a health care professional effective December 1, 2014 until November 30, 2026. 4 On December 10, 2014, Dr. Reyes moved for the reconsideration of his suspension, 5 which was denied on December 16, 2014. 6 In a letter 7 dated February 2, 2015 addressed to Dr. Reyes, PhilHealth reiterated the suspension of his accreditation, thus: CAIHTE
"x x x We regret to inform you that your accreditation with PhilHealth as a health care professional has been suspended effective December 1, 2014 to November 30, 2026, due to your suspension from the Philippine Academy of Ophthalmology, Inc. (PAO).
This action is based on the Revised Implementing Rules and Regulations of the National Health Insurance Act of 2013 (RA 7875 amended by 9241 and 10606) which states that "Findings on ethical issues by disciplinary bodies of accredited professional organizations of the PRC or specialty societies recognized by the PMA in the case of medical specialists, shall be considered in assessing the performance of health care professionals. Suspension of membership in such professional organizations shall be given consideration in assessing the continued accreditation of such professional." 8
Dr. Reyes then appealed to PhilHealth's Board (Board). In its Decision 9 dated June 22, 2017, the Board denied the appeal and upheld the decision of the Accreditation Department. The Board held that the Accreditation Department properly applied Section 61 of the Implementing Rules and Regulations (IRR) of Republic Act No. (RA) 10606. 10 Thus, Dr. Reyes filed a petition for review 11 with the Court of Appeals (CA).
In his petition, Dr. Reyes argued that the 12-year suspension of his accreditation based on a report made by the PAO was illegal because the law only allows suspension for six months. He also contended that PhilHealth should have accorded him the right to be heard. 12
On August 7, 2018, the CA dismissed the petition. 13 First, the CA held that Dr. Reyes was not deprived of his right to due process considering that he was given the opportunity to present his side through his motion for reconsideration, and the subsequent notice of appeal with memorandum of appeal. 14 Second, PhilHealth was correct in considering the suspension of his membership with PAO under Section 61 of the IRR of RA 10606. Dr. Reyes' nearly 12-year suspension was in accordance with said provision. The CA held that it would be absurd to allow Dr. Reyes to enjoy accreditation though disallowed to practice his profession. 15 Third, the CA found that PhilHealth was even lenient with Dr. Reyes because it did not terminate his accreditation, albeit PAO's termination of his membership. 16
Dr. Reyes now comes to this Court raising the sole issue of whether he can be suspended for more than six months.
We grant the petition.
PhilHealth was established to administer the National Health Insurance Program (Program), 17 which in turn was created "to provide health insurance coverage and ensure affordable, acceptable, available and accessible health care services for all citizens of the Philippines." 18
To carry out its tasks more effectively, PhilHealth is vested with quasi-judicial powers under Section 17 of RA 7875, 19 as amended by RA 10606. 20 This includes the power "to suspend temporarily, revoke permanently, or restore the accreditation of a health care provider x x x and/or impose fines," subject to the qualification that suspension shall not exceed six months. 21 A health care provider includes a health care professional, who is a doctor of medicine, among others. 22
Under Section 44 of RA 7875, as amended by RA 10606, if the health care provider commits a violation, abuse, unethical practice, or fraudulent act which tends to undermine or defeat the objectives of the Program, the penalty shall be a fine of not less than P50,000.00 but not more than P100,000.00 or suspension of accreditation from three months to the whole term of accreditation, or both, at the discretion of PhilHealth.
Here, PhilHealth suspended Dr. Reyes for almost 12 years due to his suspension as member of PAO. PhilHealth cites as basis Section 61 of the IRR of RA 10606, which provides, thus:
Sec. 61. Accreditation Requirements for Physicians, Dentists, Nurses, Midwives, Pharmacists and Other Licensed Health Care Professionals. DETACa
xxx xxx xxx
Findings on ethical issues by disciplinary bodies of accredited professional organizations of the Professional Regulation Commission (PRC) or specialty societies recognized by the Philippine Medical Association (PMA) in the case of medical specialists, shall be considered in assessing the performance of health care professionals. Suspension of membership in such professional organizations shall be given due consideration in assessing the continued accreditation of such professionals. (Emphasis supplied.)
Section 61 specifies the requirements for accreditation of health care professionals. It requires that the suspension of membership of said professional be duly considered in assessing continued accreditation with PhilHealth. However, there is nothing in Section 61 which requires PhilHealth to impose the same penalty that a professional organization has imposed. As discussed, that matter is governed by Sections 17 and 44 of RA 7875, as amended by RA 10606. Hence, Section 61 cannot be used as a justification to ignore the maximum imposable period of suspension of accreditation on a health care professional. Besides, it is fundamental that rules and regulations issued to implement a law cannot prevail over the law itself. 23
Accordingly, PhilHealth clearly erred in ignoring the clear provision of the law when it suspended Dr. Reyes' accreditation for nearly 12 years. It could not impose a period of suspension that exceeds what is allowed by law. Since PhilHealth neither charged Dr. Reyes of any violation; nor found that he committed any abuse, unethical practice, or fraudulent act, which tends to undermine or defeat the objectives of the Program; and solely considered the sanctions imposed by PAO, the applicable provision is Section 17 of RA 7875, as amended by RA 10606. Therefore, the period of suspension imposed on Dr. Reyes should have been a maximum of six months.
Still, PhilHealth argues, citing the CA's ruling, that a suspension of less than 12 years for Dr. Reyes will result in an absurd situation where he enjoys accreditation though disallowed to practice his profession because he has ceased to be a member of PAO. We do not agree with the argument. PAO does not determine who may practice medicine, but the government, 24 specifically the Board of Medical Examiners. 25 Here, there is no showing that Dr. Reyes' certificate of registration to practice medicine had been suspended or revoked by the Board of Medical Examiners. Thus, absent any showing of such revocation, PhilHealth cannot argue that it imposed the correct period of suspension.
Since Dr. Reyes' suspension became effective on December 1, 2014, it appears that his six-month suspension had already been served. Dr. Reyes therefore argues that his suspension should have been automatically dissolved. We note that neither RA 7875, nor its amendments, specify what happens after a health care professional has finished serving his or her suspension. However, Sections 53, 61, and 63 of the IRR of RA 10606 provide the following, to wit:
Sec. 53. Types of Accreditation. — Accreditation shall be of the following types:
xxx xxx xxx
c. Re-accreditation — the accreditation that shall be given to health care providers under any of the following conditions, or any other conditions as determined by the Corporation: x x x
Professionals whose previous accreditation has lapsed or whose subsequent application was denied shall be re-accredited. x x x
d. Reinstatement of Accreditation — the restoration of accreditation after compliance to conditions following a suspension imposed by the Corporation.
xxx xxx xxx
Sec. 61. Accreditation Requirements for Physicians, Dentists, Nurses, Midwives, Pharmacists and Other Licensed Health Care Professionals. — Physicians, dentists, nurses, midwives, pharmacists and other licensed health care professionals shall comply with the following requirements to be accredited: aDSIHc
a. They must be duly licensed to practice in the Philippines by the PRC;
b. They must be members of the Program with qualifying premium contributions;
b. n They must comply with the provisions set forth in the performance commitment for professionals;
c. They must comply with any other requirements that may be determined by the Corporation.
No accreditation fees shall be imposed by the Corporation for health care professionals and shall not require a certificate of good standing or such other analogous certification for them to be accredited.
Findings on ethical issues by disciplinary bodies of accredited professional organizations of the Professional Regulation Commission (PRC) or specialty societies recognized by the Philippine Medical Association (PMA) in the case of medical specialists, shall be considered in assessing the performance of health care professionals. Suspension of membership in such professional organizations shall be given due consideration in assessing the continued accreditation of such professionals.
xxx xxx xxx
Sec. 63. Grounds for Denial/Non-Reinstatement of Accreditation. — Any of the following shall be grounds for the denial/non-reinstatement of accreditation:
a. Non-compliance with any or all of the requirements of accreditation;
b. Revocation, non-renewal or non-issuance of license/accreditation/clearance to operate or practice of the health care provider by the DOH, PRC or government regulatory office or institution;
c. Conviction due to fraudulent acts as determined by the Corporation until such time that the decision is reversed by the Appellate Court or the penalty has been fully served;
d. Change in the ownership, management or any form of transfer either by lease, mortgage or any other transfer of a health care institution without prior notice to the Corporation; or,
e. Such other grounds as the Corporation may determine.
The application of the foregoing provisions necessarily requires the determination of whether Dr. Reyes had complied with the requirements. These are factual issues, which this Court cannot determine since We are not a trier of facts. 26 Besides, PhilHealth should first be given the opportunity to rule on Dr. Reyes' reaccreditation or reinstatement, in strict compliance with the provisions of RA 7875, as amended, and its IRR.
WHEREFORE, the petition is GRANTED. The Decision dated August 7, 2018 of the Court of Appeals in CA-G.R. SP No. 152539 is REVERSED and SET ASIDE. The Decision dated June 22, 2017 of the Philippine Health Insurance Corporation in OCS-AC No. 030215-066 affirming the suspension of petitioner Dr. Mario D. Reyes' accreditation is hereby MODIFIED by reducing the period of suspension to six months. ETHIDa
SO ORDERED."
Very truly yours,
(SGD.) LIBRADA C. BUENADivision Clerk of Court
Footnotes
1.Rollo, pp. 10-21.
2.Id. at 78.
3.Id. at 69, 86-87.
4.Id. at 42, 84.
5.Id. at 67, 83.
6.Id. at 78.
7.Id. at 42.
8.Id.
9.Rollo, pp. 78-81.
10.Id. at 79; RA 10606, entitled "An act amending Republic Act No. 7875, otherwise known as the "National Health Insurance Act of 1995," as amended, and for other purposes.
11.Id. at 24-38.
12.Id. at 31.
13.Id. at 82-89; penned by Associate Justice Stephen C. Cruz, with the concurrence of Associate Justices Romeo F. Barza and Carmelita Salandanan Manahan.
14.Id. at 85-86.
15.Id. at 87-88.
16.Id. at 88.
17. RA 7875, Sec. 3 (d).
18.RA 7875, Sec. 5.
19.NATIONAL HEALTH INSURANCE ACT OF 2013.
20.Sec. 17. Quasi-Judicial Powers. — The Corporation, to carry out its tasks more effectively, shall be vested with the following powers:
xxx xxx xxx
(c) Subject to the respondent's right to due process, to suspend temporarily, revoke permanently, or restore the accreditation of a health care provider or the right to benefits of a member and/or impose fines. The decision shall immediately be executory, even pending appeal, when the public interest so requires and as may be provided for in the implementing rules and regulations. Suspension of accreditation shall not exceed six (6) months. Suspension of the rights of members shall not exceed six (6) months.
The revocation of a health care provider's accreditation shall operate to disqualify him from obtaining another accreditation in his own name, under a different name, or through another person, whether natural or juridical.
The Corporation shall not be bound by the technical rules of evidence.
21.Italics supplied.
22.A health care provider is defined in Sec. 3 (o) of RA 7875 as follows:
(1) a health care institution, which is duly licensed and accredited devoted primarily to the maintenance and operation of facilities for health promotion, prevention, diagnosis, treatment, and care of individuals suffering from illness, disease, injury, disability or deformity, or in need of obstetrical or other medical and nursing care. It shall also be construed as any institution, building, or place where there are installed beds, cribs, or bassinets for twenty-four (24)-hour use or longer by patients in the treatment of diseases, injuries, deformities, or abnormal physical and mental states, maternity cases or sanitarial care; or infirmaries, nurseries, dispensaries, and such other similar names by which they may be designated; or
(2) a health care professional, who is any doctor of medicine, nurse, midwife, dentist, or other health care professional or practitioner duly licensed to practice in the Philippines and accredited by the Corporation; or
(3) a health maintenance organization, which is an entity that provides, offers, or arranges for coverage of designated health services needed by plan members for a fixed prepaid premium; or
(4) a community-based health care organization, which is an association of indigenous members of the community organized for the purpose of improving the health status of that community through preventive, promotive and curative health services.
23.Commissioner of Internal Revenue v. Philippine Aluminum Wheels, Inc., G.R. No. 216161, August 9, 2017, 836 SCRA 645, 656.
24.Board of Medicine v. Ota, G.R. No. 166097, July 14, 2008, 558 SCRA 234, 242.
25.RA 2382, Secs. 8 & 22, as amended by RA 4224 & RA 5946.
26.Gios-Samar, Inc. v. Department of Transportation and Communication, G.R. No. 217158, March 12, 2019.
n Note from the Publisher: Copied verbatim from the official copy. Irregular alphabetical sequence.