PhilHealth quashes PHAPi claims

Philippine Health Insurance Corporation (PhilHealth) President Ricardo Morales refuted allegations made by the Private Hospital Association of the Philippines Inc. (PHAPi) that around 600 hospitals will no longer renew accreditation with PhilHealth due to unpaid claims amounting to P2.5 billion.

“Well, I find that strange because I have been talking to hospitals that were supposedly associated with PHAPi, and they are saying they want to continue with their accreditation. As a matter of fact, these three hospitals in SOCCSKSARGEN area are working with us closely to restore their accreditation,” he said.

“So it seems that this threat has no basis. And that will put them out of business quickly because many of these hospitals only survive because of Philhealth reimbursements,” he added.

Morales was referring to the suspension of PhilHealth accreditation in three hospitals in the SOCCSKSARGEN region due to suspected fraud.

He, however, did not deny that PhilHealth has account payables to some hospitals.

“We cannot discount that. We are working directly with the hospitals. There is no big corporation that has no accounts payables but this is not unmanageable. We are working to reduce the backlog and to speed up our payment.”

He also said that PHAPi should also give them the specifics so that PhilHealth could work directly with the hospitals complaining.

“We do not deny that we have a backlog but it is not that big,” he said.

Morales also disclosed that he has already talked with PHAPi President Dr. Rustico Jimenez at the office of Senator Christopher Lawrence “Bong” Go.

He said Jimenez also wants to become a member of the accreditation committee of PhilHealth.

“We frequently meet with Dr. Jimenez because I think he wants to be a member of the accreditation committee of Philhealth. But it’s beyond my call. I think (he) should address this concern to the President because it’s beyond my call if he could be a member of the board,” Morales said.

Last Monday, PHAPi published an open letter to Morales and revealed that the PhilHealth owes PHAPi unpaid claims amounting to P2.5 billion.

“The Association could not understand why the respondent hospitals are not given the opportunity to be heard in a formal hearing,” the letter read.

“We are afraid that because of these developments, many of our members are alarmed that they may experience the same fate and are now signifying their intention not to renew their accreditation for the next year,” the association added.

In another television interview, Morales said that they have already paid around P75 million in claims as of August 2019.

“Some hospitals have difficulty in processing the forms. It has something to do with the information system. We’re trying to computerize, but we are resolving that. As a matter of fact, as of August, we have paid around P75 million,” Morales said.

The PhilHealth chief also warned PHAPi that it will force patients to “pay out of pocket” if it refuses to apply for accreditation next year and issued a challenge to PHAPi president Jimenez to provide more details about the supposed unsettled reimbursements.

On the other hand, Morales said that the suspension of some erring hospitals was the result of the internal cleansing of the government-owned insurance company.

To prevent the recurrence of the fraudulent claims from PhilHealth, Morales said in an interview that they are being cautious in using public funds to stop the release of benefits to fake patients similar to the case of WellMed Dialysis Center.

“So we have to be very careful because these are public funds. That’s one reason why we are assigned here because there are reports of fraud, overpayment… So (we) tried to clean up the administration and this is the outcome of that,” he said.