Probe of unpaid claims from PhilHealth eyed

Juan Edgardo Angara

MANILA, Philippines — The Duterte administration has paid only about P6.3 billion of the P28 billion that several private hospitals claim the Philippine Health Insurance Corp. (PhilHealth) owed them since 2020 and senators are readying another investigation of the state health insurance firm to find out why.

“While P6.3 billion in hospital claims have already been released by PhilHealth to 206 health-care facilities … This is a measly amount compared to the P28 billion in unpaid claims as stated by [Private Hospitals Association of the Philippines, or PHAP],” said Sen. Juan Edgardo “Sonny” Angara, chairman of the Senate committee on finance.

Hasten processing

“This has already been an issue since last year as PHAP, during the Senate committee of the whole hearing on PhilHealth last August 2020, already raised its concerns of the collectibles/arrears … amounting to P3.6 billion,” he said.

After those hearings, PhilHealth and the hospitals agreed on a debit-credit payment method that would allow PhilHealth to make a partial payment of 60 percent of its payables, at least to hospitals in the National Capital Region and COVID-19 high-risk areas within the prescribed period of 60 days.

Angara said a legislative inquiry should help the government come up with mechanisms to hasten the processing of claims, like it did in April when it came up with the debit-credit payment method.

But in May, another hospital group, Philippine Hospital Association (PHA), headed by Dr. Jaime Almora, said hospitals’ receivables from PhilHealth remained too high, ranging from P50 million to P700 million, forcing hospitals to borrow from banks or downsize its staff and bed capacities.

Almora said PHA welcomed the probe that would not have been necessary had PhilHealth fulfilled its end of the bargain. Thus far, Almora said, PhilHealth has only paid about 15 percent of the total claims for COVID-19 cases.

Dr. Shirley Domingo, spokesperson for PhilHealth, did not respond to the Inquirer’s request for comment on the Senate inquiry.

Domingo said in an earlier message that PhilHealth had already paid P36 billion in July for 2021 claims and was still processing claims for 2020.

700 hospitals

But Dr. Jose de Grano, president of PHAP, said the claims for 2020 amount to about P28- billion debt covering the period from March to December 2020 from about 700 private hospitals.

“We are hoping that something good comes out [of] this [Senate resolution],” he said on Sunday.

Instead of paying hospitals’ claims, De Grano said PhilHealth accused hospitals of “upcasing” cases, or declaring a non-COVID case as a COVID patient in order to qualify for higher coverage or hospital reimbursement.

But de Grano said it was very unlikely for hospitals to “upcase” since the costs of treatment and doctors’ fees would have to be initially shouldered by the hospital management.

“That would be like picking up a rock to hit our heads with,” he said.