PRESIDENTIAL Spokesperson Harry Roque Jr. on Wednesday, August 25, 2021, urged state-owned Philippine Health Insurance Corporation (PhilHealth) and the private hospitals to iron out their differences.
Roque said PhilHealth should immediately reimburse the claims of private hospitals amounting to P86 billion. PhilHealth said there are only P12.9 billion worth of unpaid claims, of which 15 percent were for coronavirus disease 2019 (Covid-19) benefit packages.
He also cited a Supreme Court decision in January 2021 on the case between PhilHealth and the Urdaneta Sacred Heart Hospital, which urged healthcare institutions to deal with Philhealth “responsibly, honestly and with integrity and to refrain from employing unscrupulous methods.”
“So sana nga po parehong PhilHealth at ang ating mga providers will heed the call of the President…of the Supreme Court. Balanse naman po sila ‘no, dahil kung wala po talaga silang balanse ‘no ay hindi po magtatagumpay itong ating universal health care,” Roque said during the televised Talk to the People Address of President Rodrigo Duterte on Tuesday evening, August 24, 2021.
On Saturday, August 21, the Philippine Hospital Association of the Philippines (PHAP), Philippine Medical Association and Private Hospitals Association threatened to “disengage” from PhilHealth over trust issues and unpaid claims.
The threat was made after Philhealth issued a circular suspending the payment of claims filed by private hospitals that are undergoing investigation over “fraudulent, unethical acts, and/or abuse of authority.”
In a television interview, PHAP president Jose Rene de Grano said two of their hospital members, one in Samar and one in Davao, have shut down and declared bankruptcy because of unpaid claims with Philhealth.
He said some hospitals have also reduced work hours or decreased their workforce while others have taken out bank loans to sustain operations.
“We’ll have to really push on the disengagement process, which will probably commence in October until end of December and then we’ll see how many hospitals really will disengage and not renew their accreditation,” De Grano said.
In its statement on August 20, PhilHealth clarified that the policy suspending payment to hospitals under investigation has been in place since 2016, through Circular 2016-026.
The latest circular, 2021-0013, merely introduced additional provisions that would ensure that due process is observed before any temporary suspension of payment of claims is issued.
“The circular was issued in the spirit of proper fund management and fraud control. Fraud control is a basic tenet in managing funds,” PhilHealth said.
“All health care providers can rest assured that this policy will be enforced with respect to due process and existing rules and regulations. Likewise, this policy will affect only providers engaged in fraudulent acts against the funds entrusted to the corporation by its members,” the insurance provider added. (Third Anne Peralta-Malonzo / Marites Villamor-Ilano)