COA flags Lung Center for P22.6-M unrefunded PhilHealth payments
The Commission on Audit (COA) has reported that the Lung Center of the Philippines did not refund a total of P22.6 million in benefit payments to patients who are members of Philippine Health Insurance Corp. (PhilHealth) over the past 17 years.
The state auditor said in its annual audit report, which it released in April, that of the total P28.05 million that the Lung Center received from PhilHealth from 2002 to 2018, the hospital was only able to refund 19 percent, or P5.44 million, that its patients had made as advance payments.
The audit body said that the yearly unrefunded amounts during that period, which ranged from P132,710 to P5.68 million, “deprived the concerned patient-members of their benefit.”
It said the failure to remit the P22.6 million back to PhilHealth violated its 2009 Circular No. 42, which required accredited health care providers to refund the benefit claims of members within 60 days after the hospital received the funds from state insurance company.
“The patients’ refund from PhilHealth is a benefit payment that should be reimbursed by the accredited hospital to the patient-member for a specific confinement period,” the COA said.
Within 30 days
The necessity for a refund was usually due to an underdeduction or nonavailment of benefits at a particular hospital caused by “various circumstances at the time of hospitalization.”
Citing the same PhilHealth circular, the COA said the unclaimed funds should have been remitted back to PhilHealth within 30 days.
The COA directed the Lung Center to exert all efforts to pay the refunds to its patient-beneficiaries, or if it is unable to do so, to return the money to PhilHealth.
The Lung Center offered no explanation for its failure to refund and remit the PhilHealth benefits but made a commitment “to reconcile the account by end of CY 2019 and to notify the patients of the said refund.”
No public bidding
“In case they could not anymore find/trace the patients, then they will return the unrefunded amount to PhilHealth,” the COA reported.
In the same audit report, the COA said the Lung Center purchased oxygen and other medical gases for P6.4 million without proper public bidding.
Some irregularities flagged by the COA in the procurement process were the lack of invitation to bid, which should have been published in newspapers, and the lack of abstract of bids showing the price offers of suppliers.
The COA also said the winning supplier was not required by the hospital to post a performance security bond, contrary to the procurement law.
It said a lack of a memorandum of agreement between the Lung Center and the unnamed winning supplier raised “some doubts on the reasonableness of the price of medical gas/oxygen purchased from the supplier.”
The COA told the Lung Center that it should conduct a proper public bidding for its purchase of industrial and medical gas supply in 2019. The hospital said it would prioritize that this year.
It explained that it did not hold a public bidding due to its “many projects.” It said, however, that the purchase price for the 2018 procurement was the same as in 2015 when the supplier was first contracted.