House of Representatives

Lawmakers give PhilHealth 1 week to fix data discrepancy on unpaid hospitals

Bonz Magsambol
Isabela Representative Tonypet Albano asks PhilHealth why it claimed 99% of unsettled debts have been paid when hospital records tell otherwise

Lawmakers on Thursday, June 3, asked the Philippine Health Insurance Corporation (PhilHealth) to reconcile the data discrepancy on its unsettled claims to hospitals in one week.

At a House hearing of the Special Committee on North Luzon Growth Quadrangle, Isabela Representative Tonypet Albano grilled PhilHealth Area Vice President Walter Bacareza over his presentation, which claimed the state health insurer had already liquidated 99% of hospital claims in Cordillera Administrative Region, Ilocos Region, Cagayan Valley, and Central Luzon.

“You claimed that there has been 99% payment and I’m showing you here that you are not correct… Why is there a discrepancy between your report and the report that hospitals submitted here?” Albano asked.

Albano, however, did not give details of the supposed unpaid hospitals.

Initially, Albano gave Bacareza two weeks to give them the report but he changed his mind, citing the urgency for hospitals to get paid.

“I will only give you one week because you have people in PhilHealth. If I’m going to do it, I can do it in one week,” he said.

Bacareza added, “We’ll try our best kasi medyo marami-rami itong hospitals (because the data is for a lot of hospitals). And the data that we need is from 2017 to 2020.”

Pangasinan Representative Tyrone Agabas also requested PhilHealth to provide them the reasons for return-to-hospital (RTH) and the list of denied claims of hospitals and the justification of denials.

In April, President Rodrigo Duterte ordered PhilHealth to speed up payments of its unsettled claims to hospitals

The Private Hospital Association of the Philippines (PHAPi) said that the P6-billion unsettled worth of claims has forced their member hospitals to reduce manpower and other resources amid the surge in COVID-19 infections in the country.

In a Senate hearing on May 19, the Philippine Hospital Association (PHA) said healthcare facilities were under “severe financial distress” as the state health insurer has so far failed to fully reimburse them for millions worth of coronavirus treatments since March 2020.

PhilHealth was embroiled in a corruption scandal after its former anti-fraud officer Thorrsson Montes Keith claimed in a Senate inquiry in August 2020 that executives of the embattled agency might have pocketed around P15 billion through fraudulent schemes.

PhilHealth, however, maintained that there are no missing funds as it had already liquidated 99% of the P15 billion. (READ: CHEAT SHEET: Alleged PhilHealth anomalies uncovered in Congress probes)

Several top PhilHealth officials, including former chief Ricardo Morales, are now facing administrative charges. – Rappler.com

Bonz Magsambol

Bonz Magsambol is a multimedia reporter for Rappler, covering health, education, and social welfare. He first joined Rappler as a social media producer in 2016.