b.

Claims for non-admitted or non-treated patients

c. Extending period of confinement
d. Post-dating of claims
e. Misrepresentation by false or incorrect information
f. Misrepresentation by furnishing false or incorrect information
g. Fabrication or possession of fabricated forms and supporting documents
h. Other fraudulent acts

SECTION 170. Scale of Administrative Penalties

The following administrative penalties shall be respectively imposed on cases involving non-
fraudulent and fraudulent offenses:
a. Non-Fraudulent Offenses

Suspension of 3 months and/or Fine of not less than

First Offense
P50,000.00 but not more than P70,000.00
Suspension of 4 months and/or Fine of not less than
Second Offense
P70,000.00 but not more than P90,000.00
Suspension of 6 months and/or Fine of not less than
Third Offense
P90,000.00 but not more than P100,000.00
Fourth Offense Revocation of accreditation and Fine of P100,000.00
b. Fraudulent Offenses

Suspension of 3 months to 4 months and/or Fine of not

First Offense
less than P50,000.00 but not more than P70,000.00
Suspension of 4 months and 1 day to 6 months and/
Second Offense or Fine of not less than P70,000.00 but not more than
P90,000.00
Third Offense Revocation of accreditation and Fine of P100,000

Any member who, for purposes of claiming PhilHealth benefits or entitlement thereto, shall commit
any of the above-mentioned offenses, independently or in connivance with the health care provider,
shall suffer the penalties of a fine of not less than Five Thousand Pesos (5,000.00) but not more than
Ten Thousand Pesos (10,000.00) and/or suspension from availment of PhilHealth benefits for not
less than three (3) months but not more than six (6) months.

SECTION 171. Cumulative Application of Penalties/Recidivists

The determination of the degree of imposable administrative penalties shall be based cumulatively
on the number of the offense or offense(s) of the same classification (non-fraudulent/fraudulent)
that the appealing health care provider or member has been found guilty of in a prior case and/or
decision. Guilt on two or more counts of the same offense in a decision shall be considered as one

Implementing Rules and Regulations of Republic Act 7875 As Amended Otherwise Known As the National Health Insurance Act of 2013
72