FOURTEENTH CONGRESS OF THE) 
REPUBLIC OF THE PHILIPPINES 
) 
First Regular Session 
) 
Introduced by Senaf'or'Richard J. Gordon 
EXPLANATORY NOTE 
In 1995, Republic Act No. 7875 (R.A. 7875) was enacted creating the 
Philippine Health Insurance Corporation (PhilHealth), a government-owned and - 
controlled corporation tasked with the mandate of implementing the National Health 
Insurance Program. Twelve years later, the National Health Insurance Program 
serves more than 15 million members and 61.82 million beneficiaries with a host of 
medical benefits, but it has not been without its share of problems. 
Benefit payments amounting to millions of pesos seem to be irresistible to 
some unscrupulous health care providers. The methods and techniques employed to 
perpetuate abuses and unethical practices have increasingly become sophisticated 
and run along every generation of social health insurance. 
This bill seeks to strengthen the capability of PhilHealth for more effective 
implementation of the National Health Insurance Program against the incidence of 
fraudulent activities of both employers and health care providers. Most of the 
provisions are reiterations from the Implementing Rules and Regulations (IRR) of 
R.A. 7875, as amended by R.A. 9241. 
The bill specifically defines abuses and unethical practices and other offenses 
of health care providers, employers and members, as well as provides heavier 
penalties to be imposed upon erring health care providers, employers and members. 
It seeks to increase the amount of imposable fines for these offenses from the 
current "P10,OOO.OO to P50,OOO.OO to "P50,OOO to P100,000.00," with discretion on 
the part of the Corporation to impose such fine or suspension from three months to 
the whole term of accreditation or revocation of accreditation, or both. 
As to employers, which PhilHealth considers as partners in the effective and 
efficient implementation of the National Health Insurance Program given their role as 
the biggest contributors of the National Health Insurance Funds, the bill provides for 
penalties on the failure or refusal to register, deduct, or remit premium contributions 
of employees. Particularly, in order to balance both the interest of PhilHealth and the 
employers, the bill proposes the imposition of interest and surcharges of three 
percent (3%) per month or at any rate as may be fixed by the Corporation in case of 
delay in the remittances of premiums. The intent is to avoid litigation for the 


settlement of employers' arrears and to provide the employers with a quick 
mechanism to clear their accounts with the'Corporation. 
Moreover, the bill seeks to recognize in its Charter the vital role played by the 
informal sector in the success of the National Health Insurance Program. It would be 
in the best interest of the public for the current repiesentation of the self-employed in 
the PhilHealth Board of Directors as stated in the law to embody the entire informal 
sector. The aforesaid sector is very diverse and includes not only the self-employed 
sub-groups but also the small-scaled, occasional members such as all types of street 
vendors and sometimes those who are informally employed in the formal 
entermises. 
Finally, the bill seeks to remedy the failure of R.A. 7875, as amended, to vest 
PhilHealth with visitorial powers to ensure the effective implementation of the 
National Health Insurance Program. 
As the provisions of the bill will strengthen PhilHealth's Charter and protect its 
Fund from being indiscriminately dissipated through fraudulent activities, abuses and 
unethical practices of unscrupulous health care providers and employers, approval of 
this bill is urgently sought. 
Senator 
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FOURTEENTH CONGRESS OF THE) 
REPUBLIC OF THE PHILIPPINES 
) 
First Regular Session 
) 
Introduced by Senator Richard J. Gordon 
AN ACT 
DEFINING OFFENSES UNDER THE NATIONAL HEALTH INSURANCE 
PROGRAM (NHIP) AND PROVIDING PENALTIES THEREFOR, AMENDING FOR 
THIS PURPOSE REPUBLIC ACT NO. 7875, OTHERWISE KNOWN AS THE 
NATIONAL HEALTH INSURANCE ACT OF 1995, 
AS AMENDED, AND FOR OTHER PURPOSES 
Be it enacted by the Senate and the House of Represenfafives of the Philippines in 
Congress assembled: 
SECTION 1. Section 16 of Republic Act No. 7875, otherwise known as the National 
Health Insurance Act of 1991, as amended, is further amended to read as follows: 
"SEC. 16. Powers and Functions. - The Corporation shall have the following 
powers and functions: 
. . .  
(m) to supervise the provision of health benefits, with the power to VISIT, 
ENTER AND inspect FACILITIES [medical and financial records] of health care 
providers AND EMPLOYERS and TO SECURE COPIES OF THEIR MEDICAL, 
FINANCIAL AND OTHER PERTINENT RECORDS AND THAT OF THEIR patients 
OR EMPLOYEES, WHERE APPLICABLE, who are [participants in] BENEFICIARIES 
or members OF THE PROGRAM[, the power to enter and inspect accredited health 
care institutions, subject to the rules and regulations to be promulgated by the 
Corporation]; 
(n) to organize its office, fix the compensation of and appoint personnel as 
may be deemed necessary and upon the recommendation of the president of the 
Corporation; 


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(0) to submit to the President of the Philippines and to both Houses of 
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Congress its Annual Report which shall contain the status of the National Health 
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Insurance Fund, its total disbursements, reserves, average costings to beneficiaries, 
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any request for additional appropriation, and other data pertinent to the 
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implementation of the Program and publish a synopsis of such report in two (2) 
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newspapers of general circulation; 
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of this Act.” 
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members AS FOLLOWS: 
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The Secretary of Health; 
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A representative of employers; 
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Commission or his representative; 
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(p) to keep records of the operation of the Corporation and investments of the 
National Health Insurance Fund; and 
(9) to perform such other acts as it may deem appropriate for the attainment 
of the objectives of the Corporation and for the proper enforcement of the provisions 
SEC. 2. Section 18 of Republic Act No. 7875, otherwise known as the National 
Health Insurance Act of 1991, as amended, is further amended to read as follows: 
“SEC. 18. The Board ofDirecfors. 
(a) Composifian - The Corporation shall be governed by a Board of Directors 
hereinafter referred to as the Board, composed of [the following] THIRTEEN 
The Secretary of Labor and Employment or his representative; 
The Secretary of the Interior and Local Government of his representative; 
The Secretary of Social Welfare and Development or his representative; 
The President of the Corporation; 
A representative of the [labor] FORMAL sector; 
The SSS Administrator or his representative; 
The GSlS General Manager or his representative; 
The Vice Chairperson for the basic sector of the National Anti-Poverty 
A representative of Filipino overseas workers; 
A representative of the [Self-employed] INFORMAL sector; and 
A representative of health care providers to be endorsed by the national 
associations of health care institutions and medical health professionals. 
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The Secretary of Health shall be the ex officio Chairperson while the 
President of the Corporation shall be the Vice Chairperson of the Board. 
(b) Appointment and Tenure - The President of the Philippines shall appoint 
the Members of the Board upon the recommendation of the Chairman of the Board 
and in consultation with the sectors concerned. Members of the Boards shall have a 
term of four (4) years each, renewable for a maximum of two (2) years, except for 
members whose terms shall be co-terminous with their respective positions in 
government. Any vacancy in the Board shall be filled in the manner in which the 
original appointment was made and the appointee shall serve only the unexpired 
term of his predecessor, 
(c) Meetings and Quorum. - The Board shall hold regular meetings at least 
once a month. Special meetings may be convened at the call of the Chairperson or 
by a majority of the members of the Board. The presence of a majority of all the 
members shall constitute a quorum. In the absence of the Chairperson and Vice 
Chairperson, a temporary presiding officer shall be designated by the majority of the 
quorum. 
(d) Allowances and Per Diems. - The members of the Board shall receive a 
per diem for every meeting actually attended subject to the pertinent budgetary laws, 
rules and regulations on compensation, honoraria and allowances." 
SEC. 3. Article X, Section 44 of Republic Act No. 7875, otherwise known as the 
National Health Insurance Act of 1991, as amended, is further amended to read as follows: 
Article X 
OFFENSES AND Penalties 
SEC. 44. [Penal Provisions.- Any violation of the provisions of this Act] (A) 
AN INSTITUTIONAL HEALTH PROVIDER, after due notice and hearing, shall [suffer 
the following penalties] BE PUNISHED WITH A PENALTY OF A FINE OF NOT 
LESS THAN FIFTY THOUSAND PESOS (P50,OOO.OO) BUT NOT MORE THAN 
ONE HUNDRED THOUSAND PESOS (PlOO,OOO.OO), 
SUSPENSION OF 
ACCREDITATION FROM THREE (3) MONTHS TO THE WHOLE TERM OF 
ACCREDITATION OR REVOCATION OF ACCREDITATION, OR BOTH, AT THE 
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DISCRETION OF THE CORPORATION, UPON A FINDING THAT IT IS ENGAGED 
IN ANY OF THE FOLLOWING ACTS OR OMISSIONS: 
(1) 
PADDING OF CLAIMS, BY FILING A CLAIM FOR PAYMENT 
FROM THE NHlP FOR DRUGS, MEDICINES, SUPPLIES, 
PROCEDURES AND OTHER BENEFITS IN EXCESS OF THOSE 
ACTUALLY PROVIDED TO A BENEFICIARY. 
FABRICATION OF CLAIMS, BY MAKING IT APPEAR THAT A 
BENEFICIARY HAS BEEN CONFINED AND/OR HAS RECEIVED 
(2) 
PHILHEALTH-COVERED SERVICES IN THE INSTITUTION 
WHEN IN FACT NO CONFINEMENT OR RECEIPT OF 
SERVICES OCCURRED, OR BY FALSELY MAKING IT APPEAR 
THAT A BENEFICIARY SUFFERED FROM COMPENSABLE 
ILLNESS OR UNDERWENT A COMPENSABLE PROCEDURE, 
OR BY SUCH OTHER MACHINATIONS THAT WOULD RESULT 
IN CLAIMS FOR SERVICES NOT ACTUALLY PROVIDED. 
FILING OF MULTIPLE CLAIMS, BY FILING MORE THAN ONE 
CLAIM CORRESPONDING TO THE SAME CONFINEMENT OR 
ILLNESS OF ONE BENEFICIARY. 
EXTENSION OF PERIOD OF CONFINEMENT, BY: 
a. INCREASING THE PERIOD OF ACTUAL CONFINEMENT OF A 
BENEFICIARY; 
(3) 
(4) 
b. CONTINUOUSLY CHARTING ENTRIES IN THE DOCTORS 
ORDER OR NURSE'S NOTES AND OBSERVATION DESPITE 
ACTUAL DISCHARGE OF THE BENEFICIARY; OR 
c. SUCH OTHER MACHINATIONS THAT WOULD RESULT IN THE 
UNNECESSARY EXTENSION OF CONFINEMENT. 
(5) 
ANTE-DATING OF CLAIMS, BY ALTERATION, DELETION OR 
INTERCALATION OF DATES, IN A CLAIM THAT WOULD 
OTHERWISE BE DEEMED PRESCRIBED FOR HAVING BEEN 
MADE BEYOND SIXTY (60) CALENDAR DAYS FROM THE DATE 
OF DISCHARGE OF THE BENEFICIARY. ANY CLAIM FILED 
BEYOND THE SIXTY (60) DAY PERIOD SHALL BE DENIED, 
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EXCEPT UPON GOOD REASONS AS MAY BE DETERMINED 
SUFFICIENT BY THE CORPORATION. 
MISREPRESENTATION, 
BY 
FURNISHING 
FALSE 
INFORMATION CONCERNING ANY 
MATTER REQUIRED 
UNDER THE PROVISIONS OF THIS ACT. WHERE SUCH 
MISREPRESENTATION RESULTS IN DAMAGE TO THE 
CORPORATION, THE PENALTY SHALL BE THE MAXIMUM 
FINE AND REVOCATION OF ACCREDITATION. 
UNJUSTIFIED ADMISSION 
BEYOND ACCREDITED 
BED 
CAPACITY, BY FILING ONE OR MORE CLAIMS FOR 
BENEFICIARIES CONFINED IN EXCESS OF THE ACCREDITED 
BED 
CAPACITY 
AT 
ANY 
GIVEN 
TIME, 
WITHOUT 
JUSTIFICATION IN THE FORM AND MANNER PRESCRIBED BY 
THE CORPORATION. 
PERFORMANCE 
OF 
UNAUTHORIZED 
SERVICE, 
BY 
PERFORMANCE OF A SERVICE OR PROCEDURE NOT WITHIN 
THE INSTITUTION'S AUTHORIZED CAPABILITY, EXCEPT 
WHEN SUCH SERVICE OR PROCEDURE IS DONE TO SAVE 
LIFE IN THE CASE OF AN EMERGENCY AND REFERRAL TO A 
HIGHER CATEGORY PROVIDER IS PHYSICALLY IMPOSSIBLE. 
ABUSES AND UNETHICAL PRACTICES, INCLUDING BUT NOT 
LIMITED TO THE FOLLOWING CIRCUMSTANCES: 
a. UNSAFE OR DANGEROUS PRACTICES; 
b. IRRATIONAL OR UNNECESSARY DRUG USE; 
c. UNNECESSARY 
PERFORMANCE 
OF 
DIAGNOSTIC 
OR 
THERAPEUTIC PROCEDURES; 
d. CHARGING OR COLLECTING FROM A MEMBER AN AMOUNT 
IN EXCESS OF THE BENEFITS, INCLUDING THOSE COVERED 
BY CAPITATION OR GLOBAL BUDGETS FOR PHILHEALTH- 
COVERED SERVICES THAT PROHIBIT CHARGING OF OUT- 
OF-POCKET PAYMENTS; 
e. ENROLLMENT AND/OR RECRUITMENT OF A PERSON TO BE 
A MEMBER AND/OR PAYMENT OF PREMIUM OF A MEMBER 


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BEFORE PROVIDING HEALTH CARE SERVICES TO HIMIHER, 
FOR THE SOLE PURPOSE OF FILING A CLAIM, EXCEPT 
WHEN THE MEMBER IS ITS EMPLOYEE OR RELATIVE WITHIN 
THE FOURTH CIVIL DEGREE OF CONSANGUINITY OR 
AFFINITY; AND 
f. OTHER FRAUDULENT ACTS, INCLUDING BUT NOT LIMITED 
TO THE FOLLOWING: 
i. FAILURE OR REFUSAL TO GIVE BENEFITS DUE TO A 
MEMBER OR HISIHER DEPENDENT; 
ii. CHARGING A BENEFICIARY FOR MEDICINES AND/OR 
SERVICES WHICH ARE CHARGEABLE TO AND 
COVERED BY THE NHIP; 
iii. FAILURE OR REFUSAL TO REFUND TO A MEMBER ANY 
PAYMENT RECEIVED FROM THE NHIP, WHEN THE 
HOSPITAL CHARGES AND PROFESSIONAL FEES ARE 
FULLY PAID IN ADVANCE BY THE MEMBER, WITHIN A 
PERIOD OF THIRTY (30) DAYS FROM THE DATE OF 
RECEIPT OF THE REFUND CHECK FROM THE 
CORPORATION; 
iv. FAILURE OR REFUSAL TO ACCOMPLISH AND SUBMIT 
THE REQUIRED FORMS IN CONNECTION WITH 
SECTION 44(A)(9)(F)(lll) OF THIS ACT; 
v. FAILURE OR REFUSAL TO PROVIDE A MEMBER WITH 
THE REQUIRED FORM FOR DIRECT FILING OF CLAIMS, 
BILLING STATEMENTS, OFFICIAL RECEIPTS AND 
OTHER DOCUMENTS NECESSARY FOR THE FILING OF 
CLAIMS; AND 
vi. DELIBERATE REFUSAL TO COMPLY WITH ANY 
REQUIREMENT UNDER THIS ACT. 
(1 0) 
BREACH OF THE WARRANTIES OF ACCREDITATION, 
CONSISTING OF ANY OTHER WILLFUL OR NEGLIGENT ACT 
OR OMISSION WHICH TENDS TO UNDERMINE OR DEFEAT 
THE OBJECTIVES OF THE NHIP. 
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(B) THE PROVISIONS OF SECTIONS 44(A)(6), (9) AND (IO) OF THIS ACT 
SHALL EQUALLY APPLY TO A PROFESSIONAL HEALTH CARE PROVIDER. 
[A fine of not less than Ten thousand pesos (P10,OOO) nor more than Fifty 
thousand pesos (P50,OOO) in case the violation is committed by the hospital 
management or provider. In addition, its accreditation shall be suspended or revoked 
from three (3) months to the whole term of accreditation: Provided, however, That 
recidivists may not anymore be accredited as a participant of the Program;] 
(C) ANY MEMBER WHO, FOR PURPOSES OF CLAIMING NHlP BENEFITS 
OR ENTITLEMENT THERETO, SHALL COMMIT ANY OF THE OFFENSES 
DEFINED UNDER THIS ACT, INDEPENDENTLY OR IN CONNIVANCE WITH A 
HEALTH CARE PROVIDER, SHALL SUFFER A FINE OF FIVE THOUSAND 
PESOS (P5,OOO) AND SUSPENSION FROM AVAILMENT OF NHlP BENEFITS 
FOR NOT LESS THAN THREE (3) MONTHS BUT NOT MORE THAN SIX (6) 
MONTHS. 
[A fine of not less than Five hundred pesos (P500) nor more than Five 
thousand pesos (P5,OOO) and imprisonment of not less than six (6) months nor more 
than one (1) year in case the violation is committed by the member.] 
(D) (1) [Where the violations consist ofl ANY EMPLOYER WHICH FAILS OR 
REFUSES [failure or refusal] to REGISTER ITS EMPLOYEES OR TO deduct 
contributions from the employee’s compensation ANDlor to remit the same to the 
Corporation[, the penalty] shall be PENALIZED WITH a fine of not less than Five 
THOUSAND [hundred] pesos (P5,OOO) [(P500) but not more than One thousand 
pesos (Pl,OOO)] multiplied by the total number of employees OF [employed by] the 
firm, and imprisonment of not less than six (6) YEARS [months but not more than] 
AND one (1) DAY TO TWELVE (12) YEARS [year. Provided, furfher, That in the 
case of self-employed members, failure to remit one’s own contribution shall be 
penalized with a fine of not less than Five hundred pesos (P500) but not more than 
One thousand pesos (PI ,OOO).] 
(2) Any employer or any officer authorized to collect contributions 
under this Act who, after collecting or deducting the monthly contributions 
from his employee’s compensation, fails to remit the said contributions to the 
Corporation within thirty (30) days from the date they become due shall be 
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presumed to have misappropriated such contribution and shall suffer the 
penalties provided for in Article 315 of the Revised Penal Code. 
(3) Any employer who shall deduct directly or indirectly from the 
compensation of the covered employees or otherwise recover from them his 
own contribution on behalf of such employees shall be punished by a fine [not 
exceeding] OF [One] FIVE thousand pesos (P[l] 5,000) multiplied by the total 
number of employees employed by the firm,[or] AND imprisonment FOR not 
[exceeding one (I)] LESS THAN SIX (6) YEARS AND ONE DAY BUT NOT 
TO EXCEED TWELVE (12) years.[, or both fine and imprisonment, at the 
discretion of the Court.] 
(E) If the [act or omission] OFFENSE penalized by this Act be committed by 
an association, partnership, corporation or any other institution, its managing 
directors or partners or president or general manager, or other persons responsible 
for the commission of the said act, shall be liable for the penalties provided for in this 
Act and other laws for the offense. 
(F) Any employee of the Corporation who receives or keeps funds or property 
belonging, payable or deliverable to the Corporation, and who shall appropriate the 
same, or shall take or misappropriate or shall consent, or through abandonment or 
negligence, shall permit any person to take such property or funds [wholly or 
partially], shall [likewise] be liable for imprisonment of not less than six (6) years and 
not more than twelve (12) years and a fine of not less than Ten thousand pesos 
(P10,OOO) nor more than Twenty thousand pesos (P20,OOO). Any shortage of the 
funds or loss of the property upon audit shall be deemed prima facie evidence of the 
offense. 
(G) CRIMINAL ACTION ARISING FROM A VIOLATION OF THE 
PROVISIONS OF THIS ACT MAY BE COMMENCED BY THE CORPORATION OR 
THE EMPLOYEE CONCERNED, WHERE APPLICABLE, EITHER UNDER THIS 
ACT OR UNDER THE REVISED PENAL CODE: PROVIDED, THAT SUCH 
CRIMINAL ACTION MAY BE FILED BY THE CORPORATION IN THE CITY OR 
MUNICIPALITY WHERE THE VIOLATION WAS COMMITTED OR IN METRO 
MANILA, AT THE OPTION OF THE CORPORATION. 
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(H) THE FOLLOWING CIRCUMSTANCES SHALL AFFECT THE GRAVITY 
OF THE VIOLATION AND THE LIABILITY OF THE HEALTH CARE PROVIDER, 
MEMBER OR EMPLOYER: 
(1) MITIGATING CIRCUMSTANCES, INCLUDING: 
(A) VOLUNTARY ADMISSION OF GUILT; 
(B) LACK OF DEROGATORY RECORD; OR 
(C) SUCH OTHER CIRCUMSTANCES AS MAY BE 
DETERMINED BY THE CORPORATION. 
(2) AGGRAVATING CIRCUMSTANCES, INCLUDING: 
(A) PREVIOUS CONVICTION OF AN OFFENSE AS 
PROVIDED FOR IN THIS ACT; 
(B) CONNIVANCE AND/OR 
CONSPIRACY WITH AN 
OFFICER OR EMPLOYEE OF THE CORPORATION TO FACILITATE 
OR CONCEAL THE COMMISSION OF THE VIOLATION; 
(C) GROSS NEGLIGENCE; OR 
(D) SUCH OTHER CIRCUMSTANCES AS 
MAY BE 
DETERMINED BY THE CORPORATION. 
(I) ANY PENALTY IMPOSED UNDER THIS ACT SHALL CARRY WITH IT 
THE DENIAL OF PAYMENT OF THE CLAIM IN QUESTION AND THE REFUND TO 
THE CORPORATION OF ANY AMOUNT ALREADY PAID BY IT. 
THE CORPORATION MAY IMPOSE INTEREST AND SURCHARGES OF 
THREE PERCENT (3%) PER MONTH OR AT ANY RATE AS MAY BE FIXED BY 
THE CORPORATION IN CASE OF ANY DELAY IN THE REMITTANCE OF 
CONTRIBUTIONS WHICH ARE DUE WITHIN THE PRESCRIBED PERIOD. 
(J) SUSPENSION SHALL BE CARRIED OUT BY THE TEMPORARY 
CESSATION OF THE BENEFITS OR PRIVILEGES UNDER THE NHIP. 
IF THE PENALTY OF SUSPENSION IMPOSED AGAINST A HEALTHCARE 
PROVIDER EXCEEDS THE VALIDITY OF THE CURRENT ACCREDITATION, THE 
RENEWAL OR THE RE-ACCREDITATION OF THE LATTER SHALL NOT BE 
ACTED UPON UNTIL THE FULL TERM OF THE SUSPENSION IMPOSED HAS 
BEEN SERVED OR LIFTED. FOR THIS PURPOSE, THE PERIOD COVERING THE 
EXPIRATION OF ACCREDITATION AND THE START OF THE EFFECTIVITY OF 
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THE RENEWAL AND/OR RE-ACCREDITATION SHALL BE CONSIDERED AS 
PART OR CONTINUATION OF THE SUSPENSION. 
SHOULD THE AGGREGATE PERIOD OF SUSPENSION IMPOSED UPON 
THE HEALTH PROVIDER ON ACCOUNT OF TWO OR MORE VIOLATIONS 
EXCEED TWENTY-FOUR (24) MONTHS, THE MAXIMUM LENGTH OF THE 
PENALTY SHALL BE IMPOSED. 
A HEALTH CARE PROVIDER WHO AT THE TIME OF TRIAL FOR AN 
OFFENSE ENUMERATED HEREIN SHALL 
HAVE 
BEEN PREVIOUSLY 
CONVICTED BY FINAL JUDGMENT FOR ANY OFFENSE UNDER THIS ACT MAY 
NO LONGER BE ACCREDITED AS PARTICIPANT OF THE NHIP. 
IN ALL CASES WHERE A DECISION IS RENDERED AGAINST A HEALTH 
CARE PROVIDER, THE DEPARTMENT OF HEALTH (DOH), PROFESSIONAL 
REGULATIONS COMMISSION (PRC) AND/OR OTHER CONCERNED AGENCIES 
SHALL BE FURNISHED WITH A COPY OF THE SAME. 
A NOTICE OF SUSPENSION FOR THE INFORMATION OF THE PUBLIC 
SHALL BE POSTED IN CONSP lCUOUS PLACES AND / OR IN THE INSTITUTION 
CONCERNED INDICATING THE PERIOD OF SUSPENSION IN SUCH FORM AND 
MANNER TO BE PRESCRIBED BY THE CORPORATION. 
(K) WHEN AN INSTITUTIONAL HEALTH CARE PROVIDER CEASES 
OPERATION OR AN INDEPENDENT HEALTH CARE PROFESSIONAL STOPS 
HlSlHER PRACTICE BEFORE SERVING THE SUSPENSION, EXECUTION OF 
PENALTY SHALL BE DEFERRED, TO BE IMPLEMENTED WHEN THE SAME 
OWNER OR MEDICAL DIRECTOR OPENS OR OPERATES A NEW INSTITUTION 
IRRESPECTIVE OF THE NAME OR LOCATION, OR WHEN THE HEALTH CARE 
PROVIDER PRACTICES AGAIN: PROVIDED, THAT THE DISPOSITIVE PART OF 
THE RESOLUTION REQUIRING PAYMENT OF FINES, REIMBURSEMENT OF 
PAID CLAIM OR DENIAL OF PAYMENT SHALL BE IMMEDIATELY EXECUTORY. 
A SPOUSE OR RELATIVE WITHIN THE SECOND DEGREE OF 
CONSANGUINITY OR AFFINITY OF THE OWNER OR MEDICAL DIRECTOR 
SHALL BE PRESUMED TO BE THE ALTER EGO OF SUCH OWNER OR 
MEDICAL DIRECTOR FOR THE ABOVE PURPOSES. 
DESPITE THE CESSATION OF OPERATIONS OR PRACTICE OF A 
HEALTH CARE PROVIDER WHILE THE COMPLAINT IS BEING HEARD, THE 
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PROCEEDING SHALL CONTINUE UNTIL RENDITION OF JUDGMENT FOR 
PURPOSES OF DETERMINING FUTURE RELATIONSHIPS BETWEEN THE 
CORPORATION AND THE ERRING HEALTH CARE PROVIDER. 
(L) COMPLAINTS ALREADY FILED WITH OR UNDER DELIBERATION BY 
APPROPRIATE BODIES OF THE CORPORATION PRIOR TO THE EFFECTIVITY 
OF THIS ACT SHALL BE GOVERNED IN ACCORDANCE WITH THE PREVIOUS 
ACTS AND THEIR IMPLEMENTING RULES AND REGULATIONS. 
(M) All other violations [involving funds] of the PROVISIONS OF THIS ACT 
OR OF THE RULES AND REGULATIONS PROMULGATED BY THE Corporation 
shall be PUNISHED BY A FINE OF NOT LESS THAN FIVE THOUSAND PESOS 
(P5,OOO) NOR MORE THAN TWENTY THOUSAND PESOS (P20,000), OR 
IMPRISONMENT FOR NOT LESS THAN SIX (6) YEARS AND ONE (1) DAY BUT 
NOT TO EXCEED TWELVE (12) YEARS OR BOTH, AT THE DISCRETION OF THE 
COURT [governed by the applicable provisions of the Revised Penal Code or other 
laws, taking into consideration the rules on collection, remittances, and investment of 
funds as may be promulgated by the Corporation]. 
SEC. 4. implementing Rules and Regulations. - The Philippine Health 
Insurance Corporation (PhilHealth) shall issue the necessary rules and regulations to 
implement the provisions of this Act. 
SEC. 5. Repealing Clause. - All laws, decrees,,orders, rules and regulations 
or other issuances or any part thereof inconsistent with the provisions of this Act are 
hereby repealed or modified accordingly. 
SEC. 6. Separability Clause. - If any portion or provision of this Act is 
declared unconstitutional, the remainder of this Act or any provisions not affected 
thereby shall remain in force and effect. 
SEC. 7. Effectivify. - This Act shall take effect fifteen (15) days after the 
completion of its publication in the Official Gazette or in at least two (2) national 
newspapers of general circulation in the Philippines. 
Approved, 
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