Quimbo on halt to PhilHealth claims: Probe fraud, not suspend payments
FILE PHOTO: Marikina 2nd District Rep. Stella Quimbo delivers a privilege speech on Monday, November 16, 2020, at the House of Representatives. (File) Photo from the House of Representatives
MANILA, Philippines — The Philippine Health Insurance Corporation (PhilHealth) can avoid alleged fraudulent claims from hospitals by investigating incidents and not suspending payments, Marikina 2nd District Rep. Stella Quimbo said on Tuesday.
But Quimbo, during the House committee on health hearing on PhilHealth’s temporary suspension of payment of claims (TSPC), also expressed doubts as to whether the state insurer can actually implement it with only two lawyers assigned per regional office and two lawyers in the central office’s legal sector.
PhilHealth recently issued Circular 2021-0013 which includes additional provisions to strengthen its previous policy in TSPC, which suspends payments to hospital claims to avoid further losses in income.
“Dalawa (lawyers)? Paano ninyo aasahan na meron kayong 9,496 accredited hospitals at iniisip ninyo na baka maraming or talamak ang fraud pero dalawa lang po kayong pwedeng mag-prosecute. Paano niyo po mapapatupad itong TSPC? Hindi po ba problema ng capacity ang hinaharap ninyo more than the TSPC?” Quimbo asked.
(Only two lawyers? How can you expect to have 9,496 accredited hospitals thinking that fraud is rampant and you only have two people who can prosecute? How can you implement this TSPC? Don’t you think that you are facing capacity problem more than the TSCP?)
READ: PhilHealth tightens rules on claims to stop further losses
Acting PhilHealth Senior Manager Ernesto Barbado Jr. of the Fact-Finding Investigation and Enforcement Department, said that he does not know the exact number of lawyers handling fraud cases.
Senior Vice President Jose Mari Tolentino who heads PhilHealth’s Legal Sector also noted that he is not sure how many of the 301 staffers in the regional outlets’ legal offices are actually lawyers, but it would range to around one or two per regional site.
“Actually ‘yong si Atty. Barbado po is the head of one of the departments under the legal sector, dito sa central office. Tama po ‘yong sinabi niya na sa mga regions merong pro-legal. Sa mga provincial legal natin, we have 117 plantilla positions, 65 casual, and 119 job order, so pang buong Pilipinas po ‘yan, a total of 301,” Tolentino said.
(He is correct when he said there are pro-legal in the regions. In our provincial legal, we have 117 plantilla positions, 65 casual, and 119 job order, so all over the Philippines, there’s a total of 301.)
“I do not have the exact numbers pero kung sa regions, per region maximum po ay dalawang abugado sa isang regional office […] Meron pa nga ho kaming mga ilang pro-legal offices na under bar [two lawyers per regional office maximum… we also have a few pro-legal offices that is under bar],” he added.
For this, Quimbo scolded PhilHealth for not even knowing their offices’ strength as they look to implement the TSPC provisions.
“Sir, kayo po ‘yong head ng opisina, kayo ‘yong heneral, hindi niyo po alam kung ilan ang sundalo niyo? Matatalo po kayo sa giyera nyan [You are the head of the office, the general, you do not know how many soldiers you have? You will be defeated in the battle for that],” she noted.
“So clearly napaka-kaunti ng 1 or 2 per region. So papaano natin aasahan na mapatupad ang isang new and improved TSPC? Sa palagay ko talaga medyo malabo po ‘yan [One to two per region is small. So how can we expect to implement the new and improved TSCP]?” she added.
PhilHealth has been justifying its move to update the circular, saying that it would ensure proper fund management and fraud control. However, several lawmakers and hospital representatives lamented that this had to happen amid the COVID-19 pandemic, when hospitals and healthcare workers have their hands full especially during the surge in cases.
The House panel vowed to address the issue and to link hospitals and PhilHealth, especially after several hospitals have vowed to reconsider their ties with the state insurer as the circular conveys a feeling of being mistrusted.
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