Malacanang and 20 big business groups on Wednesday called on the Philippine Health Insurance Corporation (PhilHealth) to resolve its differences with private hospitals amid the latter’s threat to cut ties with the state health insurer—possibly by October.
Presidential Spokesperson Harry Roque Jr. said PhilHealth should immediately reimburse the claims of private hospitals amounting to P86 billion.
PhilHealth has said there are only P12.9 billion worth of unpaid claims, of which 15 percent were for coronavirus disease 2019 (COVID-19) benefit packages.
Still, the business groups led by the Philippine Chamber of Commerce and Industry, American Chamber of Commerce, and the Makati Business Club called for the efficient and speedy processing of reimbursements due to healthcare providers (HCPs) by PhilHealth.
The biz groups’ statement noted that the recent PhilHealth Circular 2021-0013 on the Temporary Suspension of Payment of Claims (TSPC) due to alleged reports of fraud, unethical practices, and abuse of authorities against some HCPs that are subject of investigation “will further delay the processing of claims by local hospitals.”
The joint statement was signed by ACI Philippines, American Chamber of Commerce of the Philippines, Cebu Business Club, Cebu Leads Foundation, CIBI Foundation Inc., Filipina CEO Circle, Financial Executives Institute of the Philippines, Guild of Real Estate Entrepreneurs and Professionals Inc., Judicial Reform Initiative, Licensing Executives Society of the Philippines;
Makati Business Club, Management Association of the Philippines, Philippine Bar Association, Philippine Bar Association, Philippine Chamber of Commerce and Industry, Philippine Council of Associations and Association Executives, Philippine Finance Association Philippine Women’s Economic Network, Philippine Life Insurance Association, Philippine Retailers Association, and Women’s Business Council Philippines.
“We recognize that Philhealth needs to exercise reasonable caution against false or illegal claims. At the same time, sanctity of contracts must be respected as required by our rule of law system and delayed reimbursements to HCPs have to be addressed with urgency through, among others, simplified and more efficient claim process and consistent application of policies and rules,” the groups said.
“We are deeply concerned that the present situation increases the potential for financial losses which may lead to bankruptcy and eventual closure of our HCPs. This is unacceptable at this critical time when our country needs a strong health care system to combat the pandemic that has been wreaking havoc to our economy and causing undue hardship and suffering to our people.”
Meanwhile, Senator Imee Marcos on Wednesday called for a review of PhilHealth’s “abuse of quasi-judicial powers,” as hospitals threaten to cut ties with the state-run insurance agency over the delayed payment of claims.
She said PhilHealth’s plan to temporarily suspend the payment of claims before the end of August “highlights the need to curtail the agency’s overarching control.”
“PhilHealth’s simultaneous investigation and suspension of reimbursement claims is coercion, not an anti-fraud effort,” Marcos said.
Senator Risa Hontiveros on Tuesday filed a resolution seeking an investigation into the payment claims issues between the PhilHealth and private hospitals.
She filed Senate Resolution No. 880 after the state-insurer issued Circular No. 2021-0013 which suspends payment of claims “subject of investigations pertaining to fraudulent, unethical acts, and/or abuse of authority” for a period of 120 days.
“Which translates to 4 months, which is just untenable in the middle of a pandemic,” Hontiveros told ANC’s Headstart Wednesday.
Marcos also related allegations of “attack-and-collect,” saying members of the PhilHealth legal office would threaten hospitals with false fraud charges and suspension.
“I know PhilHealth chairman (Dante) Gierran to be a competent and upright public servant. But some officials in his Legal department have been known to be the opposite,” Marcos said, without citing any specific cases.
“Billions in dormant PhilHealth funds should be released and put to work ASAP. These are not meant to just keep earning interest in the bank during a global health crisis,” Marcos added.
On Tuesday, Health Secretary Francisco Duque III said 87 percent of the country’s population have been registered with PhilHealth.
PhilHealth’s Acting Vice President Lemuel Untalan said around 22 million were subsidized by PhilHealth.
“At present, our proposal for the P71 billion fund for this year is about 22 million Filipinos. Those were the ones subsidized by the government,” Untalan said in a mix of Filipino and English, adding that if their dependents are included, it could reach at least 50 million Filipinos.
