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Thursday, March 28, 2024

Palace to PhilHealth: Pay up, settle bills and charge the crooks

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Malacanang on Monday called on the Philippine Health Insurance Corp. (PhilHealth) to immediately pay private hospitals and file cases against those involved in fraudulent claims.

Presidential spokesman Harry Roque issued the call after the Philippine Medical Association (PMA), the Philippine Hospital Association (PHA), and the Private Hospital Association of the Philippines (PHAP) threatened to disengage with PhilHealth for temporarily suspending the payment of claims.

PhilHealth issued Circular No. 0013 on the temporary suspension of payment of claims, stating that the measure was meant to control fraud after the agency was investigated for its P153.7 billion in losses from 2013 to 2018.

The House Committee on Health, led by panel chair Quezon City Rep. Helen Tan, will hold a “dialogue” between the state health insurer and PHAP today (Tuesday) over the circular.

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“We want to hold a dialogue between PhilHealth and the hospitals. We do not want the bridge to collapse. We want to rebuild whatever trust and partnership that are left between the state health insurer and our healthcare institutions or providers,” Tan said.

But Roque said under the Universal Health Care Law, it is the government that pays for medical goods and services for PhilHealth-covered treatments. The unpaid claims, he said, would derail the law.

“PhilHealth should pay up because this is not about lack of funds,” Roque said.

“We cannot implement the UHC law with just the public hospitals, especially with the ongoing pandemic,” he added.

Roque, the primary author of the UHC Law in the 17th Congress, urged PhilHealth to pay private hospitals, reminding them of their duty as the sole purchaser of all medical goods and services.

While Roque acknowledged there were fraudulent claims, these could be prosecuted and should not lead to the blacklisting of hospitals.

“Pay what you have to pay. There has to be cooperation. PhilHealth needs to pay them faster,” Roque said.

PhilHealth, meanwhile, denied that it owes P86 billion to a number of hospitals since the start of the COVID-19 pandemic.

PhilHealth said its unpaid claims only amounted to P12.9 billion, and are in varying stages of processing, said Shirley Domingo, PhilHealth vice president for corporate affairs.

“There is no such thing as P86 billion in claims,” Domingo said in an interview on ANC’s Dateline Philippines.

“They added the claims they were processing with the claims already denied,” Domingo said.

Of the P12.9 billion claims being processed, about 15 percent are COVID-19 claims, Domingo said.

“We are processing our regular claims, our good claims in 43 days. It’s the COVID claims that’s the issue,” she said.

Domingo did not say what PhilHealth’s average turnaround time is for the processing of COVID-19 claims, but said that the state insurer would never reach a “zero-zero claims processing status” as it continues to process about 1 million claims a month.

Domingo also defended an updated PhilHealth circular on the suspension of payments of claims, saying hospitals and claimants should not be wary of the policy.

“The circular has been there since 2016. The provisions of these new circulars give them more protection… because it has a provision on due process,” Domingo said.

“We will still pay for the claims pending with us,” she said.

The circular simply addressed “the issue of fraud and sustainability of the fund,” she said.

President Rodrigo Duterte earlier ordered the state insurer to settle its debt to hospitals as soon as possible as facilities continue to receive more patients as the COVID-19 pandemic rages on in the Philippines.

Meanwhile, Deputy Speaker Bernadette Herrera said PhilHealth may have overstepped its powers when it suspended the payment of claims of some hospitals and health care providers.

“In the time of pandemic, PhilHealth cannot abuse its powers to the detriment of the country’s health care system, including our medical frontliners who have been fighting against the coronavirus since the start of the health crisis last year,” Herrera said.

Herrera said PhilHealth must also think about the welfare of its members who will be deprived of universal access to health care services with the suspension of payment of hospital claims.

“PhilHealth should be reminded of its mandate under the Universal Health Care Act, which is to provide every Filipino the highest possible quality of health care that is accessible, efficient, equitably distributed, adequately funded, fairly financed, and appropriately used by an informed and empowered public,” Herrera said.

PhilHealth said it issued the circular to prevent further wastage of funds lost to irregular claims.

However, the Philippine Medical Association, Philippine Hospital Association, and the Private Hospital Association of the Philippines said the circular was “baseless” and “unacceptable.”

Herrera urged PhilHealth to hold a dialogue with the health care providers to address the matter and prevent the issue from getting blown out of proportion.

Senators, on the other hand, urged PhilHealth and hospital groups to find a middle ground to straighten out their disagreements over the payment of claims.

Senators Grace Poe and Christopher Go appealed to PhilHealth to thoroughly discuss the issues on hand so as not to affect PhilHealth members, especially during a pandemic.

Poe said the well-being of PhilHealth members is on the line if the standoff goes unresolved. Go added that PhilHealth and the hospitals should prioritize the welfare of ordinary Filipinos who need their services now more than ever.

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