Case Digest (G.R. No. 228572)
Facts:
The case Tiong Bi, Inc. vs. Philippine Health Insurance Corporation (PhilHealth), G.R. No. 229106, was decided on February 20, 2019, by the Second Division of the Supreme Court. Tiong Bi, Inc., the petitioner and owner of Bacolod Our Lady of Mercy Specialty Hospital, is accused of "Padding of Claims" and "Misrepresentation by Furnishing False and Incorrect Information," based on actions allegedly taken by two PhilHealth-accredited eye surgeons using the facilities and staff of Tiong Bi. The fraudulent charges asserted that prescriptions were inflated and necessary medical supplies, such as oxygen and intravenous fluids, were unnecessarily prescribed or never provided to patients.On August 1, 2008, PhilHealth's Arbitration Department dismissed the charges against the two surgeons, which the PhilHealth Board also upheld. However, a subsequent PhilHealth Board Resolution, No. 2040, S. 2016, modified the earlier decision and found Tiong Bi guilty of fraudulent offenses, result
Case Digest (G.R. No. 228572)
Facts:
- Background and Nature of the Case
- The petitioner, Tiong Bi, Inc.—owner of Bacolod Our Lady of Mercy Specialty Hospital—filed a petition for review on certiorari under Rule 45 of the Rules of Court.
- The petition challenges the decisions of the Court of Appeals (CA) denying its Extremely Urgent Motion for Immediate Issuance of a Temporary Restraining Order (TRO).
- Charges and Underlying Controversy
- The petitioner was charged with “Padding of Claims” and “Misrepresentation by Furnishing False and Incorrect Information” by the Philippine Health Insurance Corporation (PhilHealth).
- The charges were linked to alleged fraudulent benefit claims involving the padding of prescriptions and the recommending of unnecessary medicines and supplies, such as oxygen and intravenous fluids, which were not provided by the hospital or the doctors.
- These charges stemmed from a prior controversy involving two PhilHealth-accredited eye surgeons, whose charges were dismissed by PhilHealth’s Arbitration Department (Decision dated August 1, 2008) and subsequently affirmed by the PhilHealth Board.
- Administrative Proceedings and Sanctions
- In PhilHealth Board Resolution No. 2040, S. 2016 dated February 24, 2016, the petitioner was found guilty for a fraudulent offense for the second time, with sanctions including:
- A suspension of its accreditation for six months and one day.
- A fine of ₱10,000.00 for each count of Padding of Claims, totaling ₱170,000.00.
- An order for the petitioner to make restitution for any payments made by PhilHealth for the subject claims, or to have such amounts deducted from its pending or future claims.
- The resolution further warned that any repetition of such offenses would attract more severe penalties.
- Litigation Before the Court of Appeals and the Motion for TRO
- The petitioner appealed the aforementioned PhilHealth Resolution to the CA through a petition for certiorari under Rule 43, simultaneously filing an Extremely Urgent Motion for Immediate Issuance of a TRO.
- The petitioner argued that:
- The PhilHealth Resolution was erroneously based on a wrong case which was heard by a different arbiter.
- Since similar charges against the two eye surgeons were dismissed for lack of merit, the charges against it should also be dismissed.
- Regarding the TRO, the petitioner contended that:
- The implementation of the disputed PhilHealth Resolution would lead to the threatened closure of its hospital.
- Such an outcome would jeopardize public health and safety, particularly in a region with few health service providers, thereby endangering patients and hampering the country’s epidemic-containment measures.
- Prior Decisions by the Court of Appeals
- On August 10, 2016, the CA denied the petitioner’s motion for TRO, finding no actual existing right requiring protection or possibility of irreparable injury.
- On January 12, 2017, the CA again denied the petitioner’s subsequent motion for reconsideration.
- Central Contentions Raised by the Petitioner
- The petitioner alleged that the CA’s decision to deny the TRO was flawed and that the remedy was improper because it was seeking relief via a petition for review on certiorari—an improper remedy for an interlocutory order.
- The petitioner argued that the denial of the TRO endangered public safety by potentially leading to the closure of a major hospital, thereby creating a health crisis.
Issues:
- Proper Remedy and Appellability
- Whether the petitioner improperly resorted to a petition for review on certiorari under Rule 45 for an interlocutory order (i.e., a TRO denial) instead of the proper remedy available under Rule 65.
- Nature and Scope of Questions in the Petition
- Whether the petition should be limited to questions of law only, given that a petition under Rule 45 cannot serve as a vehicle to re-examine factual findings or evidence.
- Standard for Issuance of an Injunctive Relief
- Whether the petitioner demonstrated the four essential elements for obtaining a TRO:
- Existence of a clear and unmistakable right to be protected.
- Direct threat to that right by the act sought to be enjoined.
- A material and substantial invasion of that right.
- An urgent and paramount necessity to prevent serious and irreparable damage.
- Assessment of Discretion
- Whether the CA abused its judicial discretion in denying the issuance of the TRO, particularly in light of the petitioner’s assertions of public health and safety concerns.
Ruling:
- (Subscriber-Only)
Ratio:
- (Subscriber-Only)
Doctrine:
- (Subscriber-Only)