PhilHealth suspends memo on suspension of hospital claims payments

MANILA, Philippines —  The Philippine Health Insurance Corporation (PhilHealth) on Sunday said it suspended the implementation of a memorandum circular that stopped the payment of hospital claims involved in fraud.

PhilHealth spokesperson Shirley Domingo, in a radio interview, said Memorandum Circular 2021-0013 was suspended following a dialogue with hospitals and Department of Health Undersecretary Leopoldo Vega.

“Napagusapan naman most of the cause was the delayed claims, na-explain naman natin ‘yon, naexplain din natin ‘yung circular context behind the circular na yon, continuous po kami makikipagusap sa kanila,” Domingo said.

(We talked that most of the cause was the delayed claims, we also explained the context behind that circular and we will talk to them continuously.”

“In the meantime, we suspended muna the implementation of that circular, habang aaralin po namin,” she added.

(In the meantime, we suspended the implementation of that circular while we review it.)

Domingo, however, reiterated that the memorandum is necessary to address insurance fraud.

“Kasi hindi rin puwede na wala tayong ganiyan kasi we have to address insurance fraud,” Domingo said.

“Hindi naman namin sinasabi na lahat ng ospital ay masama at nagcocommit ng fraud pero if there is then we have to address it we have to have policies to address this insurance fraud,” she added.

(We are not saying that all hospitals commit fraud but if there is then we have to address it. We have to have policies to address insurance fraud.)

According to Domingo, the memorandum has existed since 2016, and that it has only been implemented in 28 hospitals since 2019.

Meanwhile, no hospital claim payments were suspended by PhilHealth during the pandemic, clarified Domingo.

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/MUF