The Philippine Health Insurance Corporation (PhilHealth) has found Bacolod City’s Our Lady of Mercy Specialty Hospital (BOLMSH) guilty of fabricating claims for cataract surgeries conducted on patients recruited through medical missions.
In a 14-page decision dated September 16, the PhilHealth Arbitration Department found the hospital guilty of six counts of “padding of claims” and “breach of accreditation.”
PhilHealth ordered the hospital to pay a fine of P10,000 for each count or a total of P120,000.
It also meted a three-month suspension of the hospital’s PhilHealth accreditation for each count, or a total of 36 months.
The agency also ordered the denial of payment for the six claims found to have been padded or for the hospital to refund the health insurance agency if the claims have already been paid.
The order was issued by Darwin De Leon, Officer-In-Charge-Health Insurance Arbiter, and approved by Germain Lim, vice president, OIC-Arbitration Department.
Dr. Evangeline Johnson, BOLMSH chief executive officer, in a faxed statement said however that the hospital resolution is still subject to a motion for reconsideration and not yet final and executory.
Johnson said, "BOLMSH and its staff, nurses and doctors reserve their rights to seek due process in the proper legal forum, to bring out the truth and obtain justice."
She added, "’The hospital for all’, which was subjected to false and baseless accusations will continue to receive and admit patients both members and non-members of PhilHealth due to the hospital's social responsibility and moral obligation to safeguard the safety and well-being of the community it serves especially to the less privileged sector of our society."