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Hospital groups balk at PhilHealth pay stop

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The Department of Health (DoH) on Monday clarified that the Philippine Health Insurance Corporation’s (PhilHealth) temporary suspension of payment claims (TSPC) to healthcare providers is part of its evaluation process against false remittance.

Health Undersecretary Maria Rosario Vergeire also explained that PhilHealth has been implementing the policy since 2016 to ensure its funds are protected.

“The public must understand that this is part of the process, that whenever they evaluate claims made by our facilities or providers it is part of it,” Vergeire said.

She also clarified that the state insurer is not accusing anybody of taking advantage of the public funds, reiterating that this is part of the check and balance observed by the agency.

 

Accusing no one

“PhilHealth is not accusing anyone. This is part of the process of the government,” she said.

“We are part of the government. PhilHealth is part of the government and the money that we are spending for us to pay for these claims coming from the providers are coming from the pockets of people. So, we need to protect the funds,” she added.

Vergeire also noted that PhilHealth is now coordinating with the different healthcare providers to clarify the TSPC.

Last Friday, PhilHealth released Circular 2021-0013 “suspending payment of claims that are subject of investigations pertaining to fraudulent, unethical acts, and/or abuse of authority.”

Under this circular, PhilHealth can suspend payment claims for up to 240 days or eight months.

 

Disengaging soon?

Several healthcare providers expressed disappointment with this decision and warned of “disengagement” with the state insurer.

Three of the biggest organizations of healthcare providers in the country such as the Philippine Medical Association, Philippine Hospital Association, and Private Hospitals Association of the Philippines described the circular as “another ploy to deny or delay the payment of claims.”

“The bridge between the health care providers and PhilHealth now has serious cracks caused by a feeling of mistrust by PhilHealth against health care providers. The bridge is bound to collapse, maybe it is time to review the engagement with PhilHealth and level the playing field,” they said.

The three groups also said that the state insurer’s accusation against healthcare providers of supposed fraud is “unacceptable.”

“PhilHealth’s accusation of supposed fraud is just unacceptable. To bolster its accusation against Health Care Providers, PhilHealth came up with Circular 2021-0013,” the group said.

“Health Care Providers have come this far, its members for a long time have listened, tried to understand, pleaded, and even worked together with PhilHealth. But PhilHealth is just too far at the end of the bridge to hear the pleas of Health Care Providers,” the group added.

Despite PhilHealth’s order, the group assured the public that its members will continue to serve the PhilHealth-covered patients while their members’ contracts with PhilHealth are still in effect until December of 2021.

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