PhilHealth execs chided for slow action on members’ complaints

Health officials received a dressing down on Thursday morning during a Senate blue ribbon committee hearing for reportedly sitting on complaints by members of the state-run Philippine Health Insurance Corp. (PhilHealth) against hospitals and clinics.

Sen. TG Guingona, chair of the Senate blue ribbon committee, brought up at the third hearing on the suspicious claims amounting to P2 billion submitted by hospitals and clinics to PhilHealth that most of the 82 cases lodged in PhilHeath’s Committee on Appealed Administrative Cases (CAAC) against healthcare providers and members had been pending for up to six years.

Using a PowerPoint presentation, Guingona showed examples of hospitals and clinics charged with up to a 12th offense but which the CAAC had not acted on for years.

One of these was the administrative case against the Bacolod Our Lady of Mercy Specialty Hospital, which has not been decided for four years and eight months.

“How many more years do we need before we take action?” Guingona asked the health officials present who included Health Secretary Janette Garin.

The CAAC is a PhilHealth subcommittee that decides on complaints against healthcare providers elevated to it by PhilHealth’s arbitration committee. It is headed by former party-list Rep. Risa Hontiveros-Baraquel who assumed the post last month.

In an interview after the hearing, Guingona said the Department of Health (DOH) and PhilHealth, a state insurance firm, must address the delay in the resolution of cases.

“If no one is penalized, those eye centers and other institutions would have business as usual. No one is thus held accountable,” Guingona said.

When asked if there was incompetence and negligence on the part of the CAAC, the senator said, “The statistics speak for themselves.”

CAAC member Dr. Alexander Ayco explained at the hearing that when the CAAC members assumed their posts in 2011, they had to handle cases back to the year 2000. He also said that most of them were not lawyers.

Garin apologized profusely for what she called the “bureaucracy and lapses” within PhilHealth, which is a state insurance firm under the DOH.

“Apologies in behalf of the department and PhilHealth. There should be no excuses because if you have taken a position, that means accepting all its responsibilities,” she said.

Garin asked the Senate committee to give her department one month to institute reforms at PhilHealth.

“We do admit there were lapses that we need to correct. We apologize for what happened. We will look into the composition of responsibilities of the CAAC,” she said.

Garin said they had begun practicing the “stop order” (suspension of transactions on payment of claims), suspending payments to healthcare providers while there is an investigation.

“This will allow the fast-tracking of pending cases,” she said.

The Senate inquiry into suspicious claims filed by hospitals and clinics with PhilHealth began early this month after health officials discovered an alleged scheme of eye clinics to milk PhilHealth through eye operations that were not necessary.

Four healthcare institutions are being investigated by PhilHealth and the DOH over claims that supposedly doubled over the last two years.

The scheme dubbed the “hakot system” in which eye clinics troll for patients in the provinces was deplored by the Philippine Alliance of Patient Organizations (Papo).

Papo representative Fatima Lorenzo said at the hearing that “doctors exploited the system and the patients” they had pledged to serve.

Asked for his reaction, Dr. Raymond Evangelista, owner of the Quezon City Eye Center, told the Senate hearing the doctors were concerned about the suspension of payments for claims.

“Payments have been stopped. If we are found innocent in the end, the end could come a year and half later. A stop order for that length of time will spell doom for the eye center as well,” Evangelista said.

Garin explained that PhilHealth funds did not come from the national government but from the contributions of its members and a portion of the sin tax revenue, which amount to P38 billion a year.