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ZARSONA MEDICAL CLINIC vs.

TOPIC: RULE 7
PHILHEALTH

OCTOBER 13, 2014


PETITION FOR REVIEW ON CERTIORARI OF THE RESOLUTIONS OF THE CA
PETITIONER: Zarsona Medical Clinic (ZMC)
RESPONDENTS: Philippine Health Insurance Corporation

FACTS: P filed a claim with Philhealth for the confinement of National Health Insurance
Program (NHIP) member Lorna Alestre on 10-12 August 2003. This was denied on the ground
of “extended confinement”; the claim form and Alestre’s Salaysay stated that she was
discharged on 12 August 2003 and reported for work on the same day. Dr. Bragat, Medical
Director of ZMC, stated that the inclusive dates in the claim form was an honest mistake of the
midwife/clerk, and that the hospital’s claim was only for 2 days. Alestre subsequently executed
an Affidavit of Explanation recanting her Salaysay. She stated that she slipped out of the
hospital on the morning of 12 August to time in at work and came back to the hospital at 12nn;
went back to school and then back to the hospital at 1:30, and to school again at 2:00p.m.

PETITIONER COURT RESPONDENT


ZMC charged with violation of Sec. 149 of the Revised Implementing Rules and Regulations
of the National Health Insurance Act of 1995, for increasing the actual confinement of Alestre
(“Extending Period of Confinement”)
PHILHEALTH ARBITER
FOUND ZMC LIABLE
(Penalty: suspension from
NHIP + P10k fine)
 gave more credence
to Alestre’s
signature in the
school logbook

APPEAL PHILHEALTH BOARD


OF DIRECTORS
DISMISSED
PETITION FOR REVIEW CA
ON CERTIORARI DISMISSED
 Affidavit of Explanation, (failure of ZMC to attach valid
a notarized document, SPA; SPA does not explicitly
should weigh more than authorize Dr. Bragat to sign and
Salaysay execute verification and
certification of non-forum
shopping)

MR DENIED
PETION FOR REVIEW ON
SC:
CERTIORARI
GRANTED
 Issue: sufficiency of SPA

BAUTISTA │ ESTERON │ HIPOLITO │ MANANTAN | RAMIREZ │ PIOQUINTO │ SALES | YAMO 3-EVE


ZARSONA MEDICAL CLINIC vs. TOPIC: RULE 7
PHILHEALTH

RATIO:

1. Verification and certification against forum shopping formal, not jurisdictional requirement
 Purpose: to secure assurance that matters alleged in a pleading are true and correct
 vs. certification against forum shopping: non-compliance or a defect therein is generally
not curable by its subsequent submission or correction, unless for special
circumstances or compelling reasons
o Rule 7, Sec. 5, ROC: certification should be signed by petitioner principal
party
 Submission of an SPA authorizing an attorney-in-fact to sign the verification and
certification against forum shopping in behalf of the principal party considered as
substantial compliance with the Rules
2. The SPA granted by ZMC to Dr. Bragat is defective; this notwithstanding, ZMC should be
given the opportunity to rectify the defects in the petition
 Dr. Bragat’s powers1 do not include the filing of cases before the courts or any quasi-
judicial agency; “claims” refer to claims for payment of services rendered by the
hospital during a PhilHealth member’s confinement; no explicit authorization given
to Dr. Bragat to sign and execute the required verification and certification for non-
forum shopping
 However, the Court chose to apply liberality because of the substantial merit of the
petition  gave more credence to Alestre’s Affidavit of Explanation for the ff.
reasons:
o Alestre has fully explained to the Court’s satisfaction why she initially
misdeclared her dates of confinement in ZMC (desire to report and be
compensated for one day of work)
o Alestre’s narration clearly accounts for her whereabouts on 12 August 2003;
travelled at least 3 times to and from the hospital and school, which are 10
mins away from each other
o ZMC admitted its error in indicating the dates of Alestre’s confinement
o Salaysay was not notarized; on the other hand, the Affidavit is still a notarized
document which carries in its favor the presumption of regularity with
respect to its due execution

1
SPA in favor of Dr. Bragat: (a) to represent, process, followup, transact, and facilitate all claims, benefits and
privileges belonging to or owing to Zarsona Medical Clininc in the Philippine Health Insurance Corp., xxx and in
other agencies, xxx; (b) to receive, withdraw and encash any check or checks belonging to xxx ZMC; (c) to make,
xxx or all other writings of whatever kind and nature which are necessary to the foregoing powers”
BAUTISTA │ ESTERON │ HIPOLITO │ MANANTAN | RAMIREZ │ PIOQUINTO │ SALES | YAMO 3-EVE