PhilHealth

Iloilo City mayor files complaint vs PhilHealth execs over P952-M unpaid hospital, lab claims

Inday Espina-Varona
Iloilo City mayor files complaint vs PhilHealth execs over P952-M unpaid hospital, lab claims

Iloilo City Mayor Jerry P. Treñas sent a Letter of Complaint against the Philippine Health Insurance Corporation (PhilHealth) for the unheeded and unpaid COVID-19 related claims amounting to Php932 million (Php932,322,324.35) as of August 24, 2021. The complaint will be sent to Deputy Ombudsman Paul Elmer M. Clemente of the Office of the Deputy Ombudsman for the Visayas, and Secretrary Jerremiah B. Belgica, Director General of the Anti-Red Tape Authority. The document was signed by Mayor Treñas today, September 3, 2021. Photo by Arnold Almacen/Iloilo City Mayor's Office

Photo by Arnold Almacen/Iloilo City Mayor's Office

'The looming danger in the delay and inaction of Philhealth on the claims...is that the healthcare system of Iloilo would break down due to the lack of funds,' says Mayor Jerry Treñas

Iloilo City Mayor Jerry Treñas has filed a letter of complaint against officials of the Philippine Health Insurance Corporation (PhilHealth) in Western Visayas for the delayed payment of P932,322,324.35 in hospital and laboratory claims, saying this endangered lives amid the pandemic.

Treñas signed the letter-complaint on Friday, September 3, addressed to Deputy Ombudsman for the Visayas Paul Elmer Clemente and Anti-Red Tape Authority Director General Jeremiah Belgica. The city council passed a resolution on September 1, authorizing him to file the complaint.

“The looming danger in the delay and inaction of PhilHealth on the claims of the hospitals here in Iloilo City and the Uswag Molecular Laboratory is that the healthcare system of Iloilo would break down due to the lack of funds,” Treñas said in the complaint.

Treñas provided a breakdown of the unpaid claims as follows:

  • The Medical City Iloilo: P88,052,826.67
  • West Visayas State University Medical Center: P49,998,600.47
  • Metro Iloilo Hospital and Medical Center: P190,756,097
  • QualiMed Hospital: P30,393,677.44
  • Iloilo Doctors’ Hospital: P58,114,799
  • St. Paul’s Hospital: P95,205,705.17
  • Western Visayas Medical Center: P112,714,255
  • Iloilo Mission Hospital:  P99,645,305
  • Uswag Molecular Lab: P207,441,059

There was no figure provided for the Medicus Medical Center, which was still updating claims as the complaint was filed.

Treñas’ said the “acts” of several PhilHealth officials in Western Visayas – Valerie Anne Hollero, regional vice president; Marjorie Cabrieto, chief of health care delivery management division; and Dr. Genaline Aguirre, officer in charge of claims processing – “must be held accountable for the delay in payment.”

The complaint said local PhilHealth officials and PhilHealth president and chief executive officer Dante Gierran ignored the city’s appeals regarding the claims sent on June 18 and August 24.

Flip-flopping policies

Hollero issued a statement on behalf of Philhealth on August 26, citing payment of close to 600,000 claims. But she did not dispute the mayor’s figures. 

Hollero said the turnaround time for claims in Western Visayas is 27 days, making it the second fastest among regions nationwide. “As evidenced by the numbers, Philhealth Region VI has not been remiss in its duty to facilitate the payment of good claims,” she had said.

Hollero was referring to an August 20 Philhealth circular suspending the payment of claims “that are subject of investigations pertaining to fraudulent, unethical acts, and/or abuse of authority.”

Gierran suspended implementation of the circular on August 29 after a dressing down from legislators and hospitals’ threats to pull out of PhilHealth’s network.

Treñas’ letter-complaint noted that PhilHealth’s grounds for delaying many of the claims were based on policies that did not exist when the claims were made. 

It als said that hospitals had filed claims “in a timely manner,” using digital and electronic modes of submission, in accordance with existing policy at the time of filing.

The complaint said PhilHealth’s failure to inform claimants beforehand of policy changes governing modes of filing violated Republic Act No. 11032, the law promoting ease of doing business and efficient delivery of government services.

Treñas said PhilHealth cannot implement policies retroactively. He accused it of partiality, evident bad faith. and gross inexcusable negligence, in violation of RA 3019  or the Anti-Graft and Corrupt Practices Act.

“It is as if PhilHealth is making its rules for the release of lawful, valid, and ripe claims, as it goes along,” the complaint said.

“The rule-making power of PhilHealth through its new issuances cannot be used to impair vested rights and claims already due based on the existing policies and circulars,” it added.

On Friday, PhilHealth officials said at a House hearing that the delay and even the denial of payments to hospitals for their services from 2020 to 2021 are due to issues with paperwork.

Critical levels

The complaint said the non-payment of claims threatens the capacity of hospitals and the Uswag lab “to respond to the pandemic and comply with the directives to expand the health care system capacity amidst the surge of COVID19.”

Iloilo City and Iloilo province are among the country’s COVID-19 hotspots.

The city hosts the only tertiary hospitals and intensive care units on Panay Island. It was reverted to the high-risk category on September 1, with COVID-19 wards 94% full and intensive care units 87% occupied.

The Uswag lab plays a critical role in COVID-19 containment, Treñas and Iloilo Governor Arthur Defensor Jr. had stressed when the facility opened in November 2020. 

Defensor said at the time that the faster handling of COVID-19 tests will allow faster tracking of potential carriers. The lab can process 400 samples a day and also serves Iloilo province.

Earlier in August, the Iloilo City mayor urged the national government to invest in improving the health capacity of rural areas, noting that residents of other provinces occupy 70% of the metro’s hospital beds.

Rappler.com