CONFUSION? | PhilHealth defends position amid disengagement threats from private hospitals

August 23, 2021 , 12:39 PM

By Beatrice Puente

(August 23, 2021) – Hospitals under investigation for possible fraudulent claims will not be stripped of their right to due process, an official of the Philippine Health Insurance Corporation (PhilHealth) said on Monday, defending their recently released circular that prompted calls for disengagement.

PhilHealth spokesperson Dr. Shirley Domingo said the private hospitals that adversely reacted to the new order might have been confused in reading Circular No. 2021-0013, stressing it can grant them more favors compared to the earlier directives.

“We have to protect our funds for sustainability and (they are) public funds—we have to institute measures to be sure na protected ang fund na ito and fraud control is one,” said Domingo on Ted Failon and DJ Chacha sa Radyo 5.

Private hospitals will only have three days to refute the notice of findings from investigators, according to the order, but Domingo said they have a separate period of 10 days to review the report before that.

Only when the response lacked merit can PhilHealth issue the order on temporary suspension of payment (TSPC) for 120 days. It can be extended by another 90 days, which private hospital groups deemed unfair.

Dr. Jose De Grano of the Private Hospitals Association of the Philippines Inc. (PHAPI) did not rule out the possibility that PhilHealth might have issued the circular to delay the payment of COVID-19 claims to several healthcare providers nationwide. Domingo denied the speculation.

“May pera ang PhilHealth na pambayad ng reimbursements na ito. We have cash enough to pay our responsibility for this year and several years after. There’s money, that’s not the issue,” assured Domingo.

She also refuted claims that PhilHealth still owes P86 billion from private hospitals since they were only processing P12.9 billion as of June 30. Domingo urged hospital groups not to include rejected claims and those returned to hospitals as part of their payables when the documents were no longer with them.

But she admitted they have been slow in settling the payment of debts, particularly those related to COVID-19 since they had to grapple with policy and operational issues. She said PhilHealth has already instituted measures to iron out the process.

Domingo also dissuaded private hospital from “disengaging” with PhilHealth since it would gravely affect people’s access to health services from medical institutions. She said PhilHealth, which was rocked by a P15 billion corruption controversy last year, is always open for a dialogue.

“Disengaging from PhilHealth is not in the good of the Filipino people kasi ang ibig sabihin noon, ‘yung magbabayad direkta ay ‘yung ating mga tao, hindi na social health insurance scheme,” said Domingo. “Paano na lang ‘yung mga walang pambayad sa ospital? ‘Yung mga may pambayad, okay lang magdiretso. Pero ‘di equitable ang ganyang scheme.”

(PM)

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