PHILHEALTH vs Our Lady of Lourdes Hospital

G.R. No. 193158, Nov. 11, 2015;

PHILIPPINE HEAL TH INSURANCE CORPORATION, Petitioner, versus OUR LADY OF LOURDES HOSPITAL, Respondent.

Petitioner Philippine Health Insurance Corporation (PHIC) is a government corporation created under Republic Act (R.A.) No. 7875, as amended, to administer and implement the country's National Health Insurance Program, while respondent Our Lady of Lourdes Hospital (OLLH) is an institutional health care provider duly accredited with the PHIC.

PHIC filed a Complaint with its Legal Sector - Prosecution Department against OLLH for the administrative offense of filing multiple claims, which is penalized under Section 145, Rule XXVIII of the Implementing Rules and Regulations (IRR) of R.A. No. 7875. Allegedly, OLLH filed two claims of the same amount of PhilHealth benefits involving the same patient for the same diagnosis and covering the same period of confinement.

OLLH moved to defer the submission of its position paper pending the answer of the PHIC President and CEO to the written interrogatories as well as the inspection and copying of the original transmittal letter and all other claims of the Complaint.  According to OLLH, these modes of discovery were availed of because its representatives were denied and/or not given access to documents and were not allowed to talk to PHIC personnel with regard to the charge.

Issues:

1.  Whether or not PHIC petition should be dismissed for non-compliance on Rules on certification against non-forum shopping?

2. Whether the CA erred in annulling and setting aside the order of PHIC Arbitration Department, which denies OLLH’s resort to modes of discovery?

Held:

1. According to OLLH, PHIC Board Resolution No. 695, S. 2004, does not indicate that Alex B.  Cañaveral, who is the Officer-in-Charge of the Office of the Senior Vice-President (SVP) for Legal Services Sector (LSS) of PHIC, is duly authorized to sign the verification and certification against forum shopping at the time of the filing of the petition on September 20, 2010. Having been signed without proper authorization from the PHIC Board of Directors, the certification is defective and, therefore, constitutes a valid cause for the dismissal of the petition.

Resolution No. 694 designates, among others, the Vice-President for Legal Services Group “to sign on all verifications and certificates of non-forum shopping of all cases involving the Corporation, whether to be filed in court, administrative agency or quasi-judicial body,” while Resolution No. 1105 states that the SVP for LSS is one of those officers authorized “to represent the Corporation in any and all legal proceedings before any judicial and/or quasi-judicial bodies that may involve the Corporation, including the signing of initiatory and/or responsive pleadings including all the necessary and/or incidental legal documents relative to the legal proceedings.”

There is substantial compliance on the part of PHIC aside from the submission, albeit belatedly, of Resolution Nos. 694 and 1105, Cañaveral, by virtue of his office, is definitely in a position to verify the truthfulness and correctness of the allegations in the petition.

2. Through written interrogatories, a party may elicit from the adverse party or parties any facts or matter that are not privileged and are material and relevant to the subject of the pending action. Like other modes of discovery authorized by the Rules, the purpose of written interrogatories is to assist the parties in clarifying the issues and in ascertaining the facts involved in a case. On the other hand, the provision on production and inspection of documents is to enable not only the parties but also the court (in this case, the PHIC Arbitration Department) to discover all the relevant and material facts in connection with the case pending before it. It must be shown, therefore, that the documents sought to be produced, inspected and/or copied/photographed are material or contain evidence relevant to an issue involved in the action.

In this case, the questions contained in the written interrogatories filed and received on July 28, 2009 sought to elicit facts that could already be seen from the allegations as well as attachments of the Complaint and the Verified Answer. Specifically, the entries in the three (3) Validation Report that OLLH sought to be identified and/or explained by PHIC are either immaterial or irrelevant (to the issue of whether OLLH is guilty of filing multiple claims and OLLH’s defense that it inadvertently attached a second copy of the subject PhilHealth Claim Form 2 to the Transmittal Letter filed on June 19, 2007) or, even if material or relevant, are self-explanatory and need no further elaboration from PHIC. Thus, the interrogatories were frivolous and need not be answered. Aside from this, the PHIC Arbitration Department correctly observed that the written interrogatories were mistakenly addressed to the President and CEO of PHIC, who could not competently answer, either based on his job description or first-hand experience, issues that arose from and related to the filing and processing of claims.

By OLLH in its written interrogatories and motion for production/inspection may be addressed in a hearing to be held after submission of the position paper of the parties. If the Arbiter deemed it necessary, based on the required pleadings already submitted, a formal hearing may be conducted wherein witnesses who testify may be subjected to clarificatory questions. In such hearing, the Arbiter has the power to issue subpoena ad testificandum and duces tecum; he may issue subpoenas requiring attendance and testimony of witnesses or the production of documents and other material/s necessary. In effect, these serve the same purposes of the modes of discovery.

The foregoing considered, Arbiter De Leon did not commit grave abuse of discretion in denying OLLH's plea for written interrogatories and production/inspection of documents. His resolutions were consistent with the summary nature of the administrative proceedings, expeditiously resolving the case from the perspectives of time dimension and efficiency dimension.