Mounting PhilHealth dues hurting hospitals, says exec demanding P204M

MANILA, Philippines — Unpaid obligations of Philippine Health Insurance Corp. (PhilHealth) have financially weakened many private hospitals in the country, including Chinese General Hospital and Medical Center (CGHMC), according to Dr. James Dy, president of the private hospital.

In a letter to PhilHealth branch manager Henry Almanon on July 17, Dy said the state insurance firm owed CGHMC P204.6 million for the medical services it provided to PhilHealth members from April to June.

Dy blamed the delay in the payment collection on the adoption of new PhilHealth forms, which was implemented only in March.

In a text message to the Inquirer on Monday, PhilHealth acting president and chief executive officer Ricardo Morales declined to comment, saying he had yet to see Dy’s letter.

“Have not received this letter. Can’t comment yet,” Morales said.

Due, demandable

Of the total unpaid amount, P61.7 million was already “due and demandable” since the hospital had already complied with all the documentary requirements imposed by PhilHealth, according to Dy.

“The very poor collection from your office… results in financial debility not only of our hospital, but for most private hospitals in the health industry,” Dy said in the letter, a copy of which was obtained by the Inquirer.

“[Since] the medical services on this claim had long been served, it is grossly unfair for the state insurance system to put the financial burden of public health care on private hospital institutions, and then leave us hanging for months and years on end just to get paid,” he said.

Senate probe

He submitted a copy of his letter to Sen. Bong Go, chair of the Senate health committee, and Sen. Richard Gordon, chair of the blue ribbon committee, who will jointly head on Wednesday a legislative inquiry into irregularities in PhilHealth.

He also sent the letter to the office of Senate Majority Leader Juan Miguel Zubiri, who actively supported the passage of Republic Act No. 11223, or the Universal Health Care (UHC) Act.

In a dialogue in May, Dy said PhilHealth officials had promised CGHMC to settle the debts within 10 days, but they failed to keep their word.

PhilHealth, a government-owned and -controlled corporation mandated to provide social health insurance to Filipinos, has been under the microscope after the Inquirer published a series of investigative reports on the alleged massive corruption involving its officials and unscrupulous owners of private health facilities.

In a privilege speech on July 29, Sen. Panfilo Lacson claimed PhilHealth had already lost as much as P154 billion to overpayments and other fraudulent schemes.

Lacson said the state insurance company was financially ill as it suffered a net operating loss of P29.1 billion from 2013 to 2017 due to fund mismanagement and corruption.

In his letter, Dy pointed out that the delay in PhilHealth’s payment “negatively impacts the provision of quality health care” for Filipinos.

Citing hospital records, he said PhilHealth paid a measly P14.9 million to CGHMC for the medical services it rendered from June 14 to July 17.

But this amount, he added, was just 7 percent of PhilHealth’s total unpaid obligations to the hospital.

He said PhilHealth’s latest filing system necessitated the hospital to have another program and “reprocess” all the forms it had submitted for insurance claims worth P142.9 million.

Moreover, he said, PhilHealth had sent back collection forms to CGHMC “based on unsubstantiated reasons,” such as the unreadability of statement of accounts.

Incompatible

This problem was caused by the “incompatibility” in the electronic processing systems of PhilHealth and its technology provider, Eurolink, according to Dy.

“Any incompatibility on both systems that results in poor readability is beyond the control of the hospital, and hence, should not be blamed on the hospital,” he said.

“Simply put, the hospital should not suffer the adverse consequence of poor data integration from Eurolink to PhilHealth,” he added.

Dy said the passage of the UHC law, which required a budget of P257 billion for the first year of its implementation, warranted the removal of “organizational bureaucracy” in PhilHealth to ensure the timely payment of hospital dues.

He said PhilHealth’s critical role in attaining the law’s goals “will never be realized unless industry-wide collection is improved dramatically.”

“The confidence of the various sectors in PhilHealth’s credibility to successfully implement the provisions of this new law rests on your capability to finally clear away PhilHealth’s transactional backlog,” Dy reminded Almanon. —With a report from Jovic Yee