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    VERIFIED ANSWER

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    Verified Answer

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    Jasmin Sheryl Fortin-Castro

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    © All Rights Reserved
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    Republic of the Philippines PHILIPPINE HEALTH INSURANCE CORPORATION PROSECUTION OFFICE Citystate Centre, 709 Shaw Boulevard, Fa PHILIPPINE HEALTH INSURANCE CORPORATION, oyivppwe ABATH INSURANCE CORP. Complainant, PROSPUTION DEPARTMENT - versus ~ PROSEC Case No. 03202107- 000657 to 000663 HEMOTEK RENAL CENTER, 0320217-000712 to 000713 INC,, DR. ARNEL CHUA and 0320217-000714 to 000718 DR. JOSELITO MORA, Respondent, X-—---- X VERIFIED ANSWER (To File Verified Answer) Respondent HEMOTEK RENAL CENTER, INC., DR. ARNEL. CHUA and DR. JOSELITO MORA, through counsel, respectfully states: A. PREFATORY STATEMENT Respondents HEMOTEK RENAL CENTER, INC. (Hemotek for brevity), DR. ARNEL CHUA and DR. JOSELITO MORA stand charged of violating Section 145, 150, 153, and 163 of the Implementing Rules and Regulations of R.A 7875 for signing the respective claims form that would appear to show a double filing for the claim for the treatment of patient Venessa O. Siamen and Rafael Vda. Vera Sefiora, respectively. The Respondents DR. ARNEL CHUA and DR. JOSELITO MORA are not guilty of violating Section 145, 150, 153, and 163 of the Implementing Rules and Regulations of R.A 7875. B. STATEMENT OF THE FACTS aL By Motion dated March 27, 2023, A motion for extension of time to file Answer has been filed, requesting until April 11, 2023 to file their respective Answer/s. 2. In the present Complaint, the Prosecution alleges that on March 5, 2013, Respondent Hemotek filed a PhilHealth benefit claim for PhilHealth patient/member Rafael Vde Vera Senora (Senora for brevity) for Hemodialysis Procedure on January 28, 2013 and January 31, 2013 3. On March 26, 2013, it was claimed that Respondent Hemotek filed another Philhealth benefit claim for patient Sefiora on January 28, 2013 and January 31, 2013. 4. __ The latter claim (CE2) appeared to have been signed by Dr. Joselito Mora. 5. On May 22, 2013, Hemotek filed a claim for patient Vanessa O. Siamen (patient Slamen for bevity), for the claim April 16, 19, 23, 27, 30, 2013. 6. On June 14, 2013 Respondent Hemotek filed another claim for patient Siamen for various treatment dates which include the treatment dates April 16, 19, 23, 27, 30, 2013. The latter claim (CF2) appeared to have been signed by Dr. Arnel Chua. 7. Based on the foregoing, Philhealth filed the instant cases against Hemotek, Dr. Chua and Dr. Mora for the aforesaid alleged violations. 8. Assuming the documentations were accurate and correct, the Respondents would like to apologize for the error, but it was beyond his control. 9. According to the HEMOTEK RENAL CENTER, INC’s employee in charge of claims at that time, Ronalyn A. Ramoga, who encoded the information into the patients Sefiora and Siamen’s records, the computer used to encode and store the data sometimes freezes and, even crashes, she did not know why. 10. At that time, she was not aware but it appears that some of the data she encoded in the Excel program, more particularly the transmittal date for that treatment inserted in the worksheet column for the outpatient concerned was not saved. a. The encoding of the transmittal date in the patient’s worksheet is relevant because it indicates the date as to when the claim for the patient's treatment was filed. b. If there is no date indicated, then the claim for that treatment has not yet been processed, and consequently, it is included in the succeeding claim to be filed. c. In other words, the treatment occurred, the error relates to the saving in the Excel program of the encoded date as to when the treatment was transmitted to PhilHealth for the claim. 11. _Inyear 2013, the Respondent Hemotek was not yet fully familiar with the computerized submission of document. Likewise, the mode of filing at that time was not familiar with the personnel in charge considering that she was the only one who was in charge of the filing of ALL claims of Hemotek. 12. With all due respect and based on a perusal of the documents, the alleged double claims were for the same treatment date and for the same date, the same person and same treatment. 13. Dr. Mora and Dr. Chua signed the second forms at a later date and they would not be able to research if the said claim was already included in the previous claims of March 26, 2013 and June 14, 2013. 14. _ These respective doctors were there to prescribe the proper treatment and if the patient had his treatment claims are true. 15. The performance commitment, signed by the respective Doctors, states that: “7. Ishall strictly abide with all Administrative, Orders, Circulars and such other policies, rules and regulations issued by the Department of Health (DOH) and all other government agencies instrumentalities governing the practice of my profession and affecting my accreditation with the PHIC; 13. Lam fully aware and I unconditionally acknowledge and agree that any indication(s) adverse reports/findings of patterns or any other similar incident which may be indicative of any illegal, irregular, improper and/or unethical conduct or practice of my profession maybe a ground, at the discretion of PHIC, to suspend, shorten, pre-terminate, and/or revoke my accreditation including upper tenant benefits and opportunities incident thereto at any time during the term of my accreditation as maybe determined by the PHIC to protect the interest of the NHIP; 15. I shall promote and protect the NHIP Program against abuse, violation and/or over-utilization of its funds and I will not allow our institution to be a party to any act, scheme, plan, or contract that may directly or indirectly be Prejudicial to the program.” signing the claim form, the Respondents Dr. Mora and fied that there were indeed treatment dates availed of by the patient Sefiora and Siamen. 17. The said treatment dates were true and correct. There was no misdiagnosis nor were there any unethical practice committed by the Respondent doctor. 18. It so happened that there was an error by the personnel of Hemotek Renal Center, Inc. when she included the previously filed claims in the second claims dated March 26, 2013 and June 14, 2013 claim forms. 19. A cursory review of the documents would show that the forms attached to the Complaint pertain to the same person/ patients 20. The filing of the second treatment dates on March 26, 2013 and June 14, 2013 for Dr. Mora and Dr. Chua are palpable errors and excusable mistake because of the negligence of Hemotek Renal Center, Inc.’ former employee Ms. Ronalyn A. Ramoga. 21. At that time, she (Ms. Ramoga) was the sole employee handling all the claims of the branches of Hemotek. 22. The Respondents Dr. Mora and Dr. Chua, in their almost twenty (20) years of clinical practice and in the many years of their being accredited HCP of Philhealth have adhered to the highest standards of ethical practice. 23. They have strictly adhered to the performance commitments required of the corporation. 24. They VEHEMENTLY deny and refute and any allegations that they have willfully or maliciously participated in the alleged filing of multiple claims by the personnel of Hemotek Renal Care. 25. The Respondents Dr. Mora and Dr. Chua are not employed in any official or administrative capacity or have authority or influence to initiate or, much less, withhold a claim whether correct or not. As the attending physician of the patient, the individual Respondent doctors have a doctor-patient relationship that is based on mutual trust and is extended to the hemodialysis center. 26. The administrative filing of claims with Philhealth is the sole responsibility of the accredited healthcare institution and the attending physician fully relies on the institution’s personnel to process the same in order to be paid later on. 27. _ Having no free access to either the health care institution’s or Philhealth’s database, no statement of account or rubric provided, the individual doctors are not in a position to validate the claim-forms that are brought to the attending physician by a patient or by a health care institution's staff, are documents that are generally regarded as trustworthy and pre-vetted, and hence, are signed in good faith. 28. _ Respondent doctors have no participation in the filing of the claims which may or may not inadvertently contains the previous treatment dates that were previously filed. 2. The Respondent Dr. Mora and Dr. Chua nor the Hemotek Renal Center does not condone or institute double filing. The individual doctors inquire if there were previous filings done before signing. 30. To clarify, an attending physician's signature on the claim form merely certifies services rendered and the professional fees due him or her. The attending physician's signature merely substantiates the medical aspects of the claim form for which they have certified training or personal knowledge in—that the named individual is a patient under their care, the diagnosis including its ICD code is correct, and whether a co-pay was charged to the patient or not. There is no explicit statement or phrase in the Claim Form (CF) 2's signature field for doctors that would indicate that by signing the said document, the attending physician attests that there has been no prior claim made on the professional fees due him or her. The burden of attestation that all of the information contained in the document are true and correct for purposes of filing the claim with Philhealth is borne by the claiming healthcare institution (CF2) and that of the patient’s employer (CFI). C. ISSUES 31. Based on the charges, Section 145 states: Any health care provider who, for the purpose of claiming payment from NHIP, files two or more claims for a patient for the same confinement or illness, or makes it appear that the patient had been confined for two or more times, or for two or more different illnesses, shall be punished by a fine of not less than P10,000 but not more than P50,000. In addition, its accreditation shall be revoked or suspended from 3 months to the whole term of accreditation. while Section 150 provides: Any institutional health care provider who commits any breach of the warranties shall suffer a fine of not less than P10,000 but not more than P50,000, In addition, its accreditation shall be revoked or suspended from 3 months to the whole term of accreditation. Are Respondent Hemotek and Drs. Mora and Chua guilty of violating these charges? The answer is NO. 32 As openly admitted in the Complaint-Affidavit, based on the evidences (Annexes “A” to“D”) supporting it, more particularly the CF2 form (Annexes “C”), what is involved here is treatment for hemodialysis — and not confinement nor illness. 33. To be clear, the subject matter is the inadvertent mistake of former Hemotek employee Remoga in including the same treatment dates for the March 26, 2013 and June 14, 2013 second claims of Dr. Mora and Dr. Chua hemodialysis treatments in which were already included in the first claims. And that is not punishable under the law. D. ARGUMENTS THE FIRST CHARGE: VIOLATION OF SECTION 145 Before a person can be punished, his act must be punishable by the statute sought to be applied. 34, Toreiterate, the subject matter of Section 145 is the filing of, two or more claims for a patient for the same confinement or illness, or making it appear that the patient had been confined for two or more times or for two or more different illnesses. 35. It did not speak of, much less include, claims for “treatment”. A “treatment” is (obviously) not illness nor is it synonymous with the term confinement. a. The Oxford Dictionary defines “treatment” as. a medical care given to patient for an illness or an injury,) while confinement is the action of confining or state of being confined.? b. _ Inother words, confinement refers to inpatient care in a hospital or health care institution. This is clear by the phrase, used in Section 145 to include the act penalized: “makes it appear that the patient had been confined for two or more times”. c. In fact, the concept of confinement was repeatedly used in Rule XXVIII of the IRR where Sections 145 and 150 belong —and it was always in the context of an inpatient, pertaining to one who is actually confined in a health care institution, as used in Sections 141, 142, and 146, to wit: Section 141. Claims for Non-Admitted Patients - This is committed by any health care provider who, for the purpose of claiming payment for non-admitted patients from the NHIP, files a claim by: (a) making it appear that the patient is actually confined in the health care institution; or (b) using such other machinations that would result in claims for non-admitted patients. The foregoing offenses shall be penalized by a fine of not less than P10,000 but not more than P50,000. In addition, its accreditation shall be revoked or suspended from 3 months to the whole term of accreditation. Section 142. Extending Period of Confinement - This is committed by any health care provider who, for the purpose of claiming ' Oxtord Dictionary of English, Version 2.4, 3° Ed., Oxford University Press, 2010, 2013, ? bid. payment from the NHIP, files a claim with extended period of confinement by: (a) increasing the period of actual confinement of any patient; (b) continuously charting entries in the Doctor’s Order, Nurse’s Notes and Observation despite actual discharge or absence of the patients; (c) using such other machinations that would result in the unnecessary extension of confinement. The foregoing offenses shall be penalized by a fine of not less than P10,000 but not more than P50,000. In addition, its accreditation shall be revoked or suspended from 3 months to the whole term of accreditation. Section 146. Unjustified Admission Beyond Accredited Bed Capacity - Any health care institution which, for the purpose of claiming payment from the NHIP, files claims for patients confined in excess of the accredited bed capacity at any given time without justification in the form and manner prescribed by the Corporation shall suffer a fine of not less than P10,000 but not more than P50,000 and suspension of accreditation for 3 months to the whole term of accreditation. Simply put, the term “treatment”, is not included in the act penalized under Section 145. And since it is not included, nullum crimen poena sine lege. There is no crime when there is no law that defines and punishes it. 36. To illustrate, in the case of People of the Philippines v. Judge Amante P. Purisima,? a special law made it unlawful to carry outside of one’s residence any bladed, pointed, or blunt weapon—such as a “fan knife”, a “bolo”, a “balisong”, a “kris” or a club. And, any * People of the Philippines v. Judge Amante P. Purisima, et al, G.R. No. L- 42050-66, decided on November 20, 1978, person found guilty shall suffer the penalty of imprisonment ranging from 5 to 10 years as the court may direct. BINg 7 y bid. Wid. Wid. bid. Now ~a law-abiding citizen, a lawyer by profession, after gardening in his house remembers to return the “bolo” used by him to his neighbor who lives about 30 meters, or so, away. And, while he was crossing the street, he meets a policeman. The latter upon seeing the “bolo” being carried by that citizen places him under arrest and books him for the crime. Is the citizen guilty of violating the law, ie. Presidential Decree 9? The Honorable Supreme Court unequivocally declared NO. A law cannot be interpreted to produce such an absurd, unreasonable, and insensible result.° Whatever is within the spirit of a statute is within the statute, and this has to be so if strict adherence to the letter would result in absurdity, injustice, and contradictions.” Criminal statutes must be construed strictly. No person should be brought within their terms who is not dearly within them, nor should any act be pronounced qiminal which is not made clearly so by the statute’ And, in interpreting a law that is penal in nature the following rules of construction should be observed: The result or effects of the statute must be within its reason or intent. 10 The statute must be construed in the light of the purposes to be achieved and the evils sought to be remedied. Lastly, and as earlier stated, penal statutes are to be construed strictly against the state and liberally in favor of an accused? Respondent Dr. Mora and Dr. Chua are being persecuted on a wrong interpretation of the law. 37. To reiterate, that Section 145 (of the 2004 Rules) did not penalize multiple filing of claims for “treatment”. So, it was amended in October 2013—and became Section 155", which now reads: SECTION 155. Filing of Multiple Claims Any health care institution who files two or more claims for a patient for the same confinement or out- patient treatment or illness. 38. This 2013 Rules, however, is prospective in its application; and did not cover this incident at hand, which happened in the second quarter of 2013. 39. The FFIED’s insistence on holding Respondents Hemotek and Drs. Mora and Chua liable for something which the law applicable at the time of the incident did not punish (2004 Rules) clearly constitutes a misapplication of the law and hence, they beg the kind indulgence of the Philhealth. THE SECOND CHARGE: VIOLATION OF SECTION 150 ° wid. ® Section 155, Rule |, Title IX of the Revised Implementing Rules and Regulations of the National Health Insurance Act of 2013, IN RELATION TO 4 AND 16 OF THE “WARRANTIES” Section 150 violates the Fair Notice Rule. 40. Section 150, which provides: Any institutional health care provider who commits any breach of the warranties shall suffer a fine of not less than P10,000 but not more than P50,000. In addition, its accreditation shall be revoked or suspended from 3 months to the whole term of accreditation. 41. If what Respondents Drs. Mora and Chua are being held liable for is Section 150, by itself, Respondents do not know how to answer the charge plainly because it did not define what is “any breach”. It does not inform us what act or omission did Respondent Doctors have committed that that constitutes as breach of warranty. 42. With all due respect, the performance commitment signed by them does not explicitly mandate them to be the person who should be the person ultimately accountable and responsible for the claims filed with Philhealth. 43. Respondent Drs. Mora and Chua are not the person who prepares the claims filed with Philhealth. They only certifiy that the treatment dates were validly availed which they did certify. 44. This is a violation of Respondent Dr. Mora and Dr. Chua’s due process right to a fair notice. The fair notice rule, according to the Supreme Court requires that the penal provision must inform every person what particular conduct is being penalized," to wit: Among the components of due process, particularly concerning penal statutes, is the fair notice requirement. The Court, through Justice Sarmiento, acknowledged "Spouses Carlos and Erlinda Romualdez v. Commission on Elections and Dennis Garay, G.R. No. 167011, April 30, 2008 2 in People v. Nazario’? that a statute violates due process, and thus repugnant to the Constitution, if it fails “to accord persons, especially the parties targeted by it, notice of the conduct to avoid.” Such flaw is one characteristic of a vague statute, the other being that “it leaves law enforcers unbridled discretion in carrying out its provisions and becomes an arbitrary flexing of the Government muscle.” Both attributes earmark a statute as “vague”, the generally accepted definition of a vague statute being one that lacks comprehensible standards that people “of common intelligence must necessarily guess at its meaning and differ as to its application.” Section 150 is void for being vague. 45. Moreover, this Section 150 should be voided for being vague. It is vague because the term “any breach” not only blind sides any person who stands accused of violating the said section, but also permits the law enforcement authority to arbitrarily enforce it with impunity, like in this case. 46, In fact, the FFIED and Prosecution had to literally go out of the scope of the IRR and stretch its meaning to include the signing of claim forms as being responsible and accountable for all the claims submitted to Philhealth. 47. The Honorable Justice Tinga, in his Dissenting Opinion in the above-quoted Romualdez case, comprehensively defined the vagueness doctrine, to wit: Void-for-vagueness derives from the basic tenet of criminal law that conduct may not be treated as criminal unless it has been so defined by an authority having the institutional competence to do so before it has taken place. It requires that a legislative crime definition be meaningfully precise. 7 GR. No. L-44143, 31 August 1988, 165 SCRA 186 The inquiry into whether a criminal statute is “meaningfully precise” requires the _ affirmative satisfaction of two criteria, First, does the statute fairly give notice to those it seeks to bind of its strictures? Second, isthe statute precise enough that it does not invite arbitrary and discriminatory enforcement by law enforcement authorities? Unless both criteria are satisfied, the statute is void for vagueness. There are three concerns animating the vagueness doctrine. First, courts are rightly concerned that citizens be fairly warned of what behavior is being outlawed; second, courts are concerned because vague laws provide opportunities for arbitrary enforcement and put the enforcement decisions in the hands of police officers and prosecutors instead of legislatures; finally, where vague statutes regulate behavior that is even close to constitutionally protected, courts fear a chilling effect will impinge on constitutional rights. These three interests have been deemed by the U.S. Supreme Court as important enough to justify total invalidation of a statute, such invalidation warranted unless there is some intervening act that has eliminated the threat to those interests. In its essence, the vagueness doctrine is a critical implement to the fundamental role of the courts to rule justly and fairly. Uncertainty in statutes enables persons to be penalized for acts, which are not precisely defined in law as criminal, or for acts which are constitutionally protected but cast within an overbroad definition of a crime. 48. Thus, this incident is but a mere oversight devoid of any bad faith or malice which is one of the requirements to hold a person liable for filing multiple claims. FT 49 More importantly, the Respondents Dr. Mora and Dr. Chua, have no record of a complaint filed before the Prosecution department for any case. THE ACTION HAS PRESCRIBED 50. Finally, the action has prescribed. 51. The second claim made on or about March 26, 2013 and June 14, 2013 and the instant case was filed sometime on February 23, 2023 — after a period of almost ten (10) years. 52. Article 1149 of the Civil Code provides: “All other actions whose periods are not fixed in this Code or in other laws must be brought within five years from the time the right of action accrues. 53 Clearly, the action has prescribed as it is more than the requisite five (5) years from the filing of the second claim. 54. For the past several Answers, the issue of prescription has been raised time and time again. It is prayed that the Honorable Office answer the issue of prescription being raised. 55. The Respondents are manifesting that they shall be present, thru counsel, in case hearing is called for by this Office. PRAYER WHEREFORE, premises considered, it is prayed that after due notice and hearing, the Office dismiss the instant case for having PRESCRIBED, that a declaration of no willful breach of Section 150 of R.A. 7875; For no breach of the existing rules and regulations as of the time it was incurred. OTHER RELIEFS, just and equitable are likewise prayed for. Quezon City for Pasig City. April 5, 2023. GABRIEL & MENDOZA Law Offices Counsel for the Respondents Suite 601, Fil-Carcia Tower, 140 Kalayaan Avenue Cor. Mayaman Street, Diliman, Quezon City (02) 8463-7994; /8928-8817 gabby7112000@yahoo.com ei ie YAtfA A Aff Army baves iAuaeo. GABRIEL Roll of Attorneys No. 44006 IBP No. 298010.February 16, 2023. Quezon City PTR No. 4055215 January 9, 2023.Quezon City MCLE Compliance No. VII-001802; valid until April 14, 2025 Copy Furnished: ATTY. SHERILY B. CUA PROSECUTION DEPARTMENT he 2 He Prosecution Department PHILIPPINE He A RTMENT ‘ilhealt] Citystate Centre, 709 Shaw Boulevard R11 m8 Pasig City The foregoing was filed and served thru registered mail due to the distance between the parties and lack of adequate messengerial services to effect personal service. (Please disregard if done personally) 16 Republic of the Philippines) NoutoRibtry ss. VERIFICATION I, DR. JOSELITO MORA, Filipino, of legal age, after being duly sworn to in accordance with law, hereby depose and state THAT: 1. Tam one of the Respondents in the above-mentioned case; 2. Ihave read the Answer and caused it to be prepared; 3. All the contents thereof are true in accord with the authentic records under my possession as well as my knowledge. 4. The pleading is not filed to harass, cause unnecessary delay, or needlessly increase the cost of litigation; and The factual allegations therein have evidentiary support or, if specifically so identified, will likewise have evidentiary support after a reasonable opportunity for discovery; 9 IN WITNESS WHEREOE, I hereby set my hand this APR 11 2028 2023 in Manila City. ¢ DR. JOSELITO MORA Affiant SUBSCRIBED AND SWORN to before me, a Notary Public for Omaha CITY City, on this ___APR 112029. affiant exhibited to me his competent evidence of identity Professional Regulatory Commission ID No. with No. 0088789. Doc. No. #23; NOM pusuie Page No. &; somal tt 20 Book No. ff; Series of 2023 a PROFESSIONAL REGULATION COMMISSION S q PROFESSIONAL DE CARD usu rastwue ——- JOSELITO opus —® AQUING necsremouxe. > 0088789 reosteanowoave b 02/29/1998 vwuourm, 03/04/2025 arena i es ene ey ar a Src nes presocn aha te hts tod ee “Tris i tlcerify tutte thet helotie i 2 professional in good standing Tre tnstnmeteatiicte of regsetonfrotessionsl foense Nas not Deon 2s peed Fevoied oF winarawn Geely

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