The Commission on Audit (COA) has called the attention of the Philippine Children’s Medical Center (PCMC) for its failure to file reimbursement claims of more than P200 million for COVID-19 tests to the Philippine Health Insurance Corp. (PhilHealth) since 2021.
In its 2022 annual audit report, the COA said the PCMC did not file P197,373,246 million worth of claims for PhilHealth reimbursement in 2021 and another P2,903,600 million in 2022.
“The PCMC was unable to claim reimbursement from PhilHealth aggregating P200.277 million for the reverse transcription polymerase chain reaction (RT-PCR) test conducted by the center’s COVID-19 Laboratory covering 62,285 samples from the overseas Filipino workers collected by
Philippine Coast Guard due to the lack of supporting documents from PCG which are required by PhilHealth for the filing of claims on benefit package for SARS-CoV-2 test,” the report read.
“The non-reimbursement by PhilHealth of said claims may result in a significant loss on PCMC for the operational expenses incurred in the conduct of RT-PCR testing,” it cited.
Some of causes for the failure to file the claims were the system glitches, lack of necessary patient information and delay in the processing of papers.
“Consequently, the non-filing for reimbursement of the RT-PCR test within the prescribed period due to the issues encountered in securing the required documents and information may result in a significant loss on the part of PCMC for the operational expenses already incurred such as the salaries and professional fees of COVID-19 laboratory personnel as well as the test kits used in the conduct of the RT-PCR testing on the samples collected, swabbed, and transferred by PCG to PCMC,” the commission said.
It advised the PCMC to file a motion for reconsideration with PhilHealth for the reimbursement and find other ways to collect the P200.277 million from PhilHealth.
“Coordination with the One Stop Shop in obtaining OFWs data has been worked out and converting them to CIFs is currently ongoing. Further, a Certification from PCG to be signed and attached to the MR for PCMC’s PhilHealth claim reimbursement is being done,” the PCMC noted.