The Philippine Health Insurance Corporation (PhilHealth) has asked the Supreme Court (SC) Wednesday to reconsider its decision affirming a Commission on Audit (COA) ruling that disallowed the issuance of P83 million benefits to former’s officials and employees in 2014.
According to PhilHealth corporate communications senior manager Rey Baleña, the PhilHealth filed the motion for reconsideration in December 2022, months after the High Court dismissed the petition of the state health insurer seeking to overturn the 2018 ruling of COA for lack of merit.
“We’re exhausting all legal remedies because these benefits have enough legal basis and these were given in good faith and in recognition of the efforts of our officers and employees,” he said in an ANC interview.
In 2014, PhilHealth paid an educational assistance allowance and birthday gifts to officials and employees in the head office and regional office without the approval of then President Benigno Aquino III.
The SC said that PhilHealth revoked the concepts of fiscal autonomy, institutional authority to fix personnel compensation, and good faith. The SC further said it is already settled that PhilHealth does not have absolute discretion in determining the compensation of its officials.
Baleña, however, maintained that PhilHealth has the authority to do so, citing Republic Act 7875 or the National Health Insurance Act (NHI).
“We stand by our position that we have enough authority according to Republic Act 7875, as amended. It is basically one of the points that we have included in our motion for reconsideration,” he said.
“Since the time that our attention was called by the COA, these benefits were immediately stopped and we have complied with all the stipulations of the Salary Standardization Law,” he added, pointing out that the P83 million refers to the benefits given, and not the salary.
The PhilHealth official also said that they will comply accordingly and mandate all their employees who received the said benefits to return the amount should the decision be ruled out with finality.
“Our commitment is that if it is with finality, then we will have to return this amount. We have a program to comply. Of course, we will contact all those employees who are no longer with us now to also return,” Baleña said.
In addition, Baleña announced that PhilHealth was able to pay around P13 billion in insurance claims related to COVID-19 from 2020 to 2022.
Baleña said that they had a meeting with the Private Hospitals Association of the Philippines (PHAPI) on December 28, 2022 to inform them of the development.
“As of late, we are only down to P3.2 billion in payables with private hospitals. Some P500 million of which are still within the 60 days allowed period under the law. The rest, I may say, are backlogs,” Baleña said.
Baleña said that PhilHealth will be able to pay the private hospitals the remaining P3.2 billion in 2023.
In March 2022, the Department of Finance (DOF) said COVID-19 insurance claims reached P16.71 billion during the 2020 to 2021 period.
Baleña further said that 99.8% of the controversial P15-billion in advanced payments through its interim reimbursement mechanism (IRM) has been liquidated and “properly accounted for.”
“Again, the allegation that it was pocketed, it’s not true. All the P15 billion was accounted for. It was received by all 711 hospitals that applied for it in 2020,” he said.
The IRM is a system where PhilHealth pays hospitals and healthcare facilities in advance for insurance claims, to ensure that they could function during times of crisis.
Meanwhile, Baleña said the PhilHealth Board will convene on Wednesday to discuss which benefits need to be adjusted following the suspension of the premium rate hike.
Malacañang announced Monday that President Ferdinand Marcos Jr. ordered the Philhealth to suspend the premium rate increase to 4.5% this year from 4%, as well as the adjustment of the income ceiling to P90,000 from P80,000.
The scheduled increase is in accordance with the Universal Healthcare Law, which mandated hikes in the PhilHealth contribution rate until it reached 5% by 2024.
Baleña said Tuesday the suspension of premium rate hike would not affect PhilHealth operations but there will be adjustments in the deployment of new benefits scheduled to be implemented this year.