Commission on Audit

COA: Gov’t hospital in Palawan should refund overcharged COVID-19 patients

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COA: Gov’t hospital in Palawan should refund overcharged COVID-19 patients 

COA. The Commission on Audit on Commonwealth Avenue, Quezon City, on October 2, 2018.


COA says the Culion Sanitarium and General Hospital overcharged COVID-19 patients by P5.27 million for the cost of PPEs, and by P227,417.70 for medicines

MANILA, Philippines – A government hospital in Palawan should reimburse COVID-19 patients that it had overcharged for medicines as well as personal protective equipment (PPE) used by attending medical staff, the Commission on Audit (COA) said in its 2021 audit report on the Department of Health (DOH).

In its audit report, COA said that the Culion Sanitarium and General Hospital (CSGH) in Culion, Palawan, overcharged COVID-19 patients by P5.27 million for the cost of PPEs, and by P227,417.70 for medicines.

Following the discovery, COA recommended that the health secretary direct the CSGH medical center chief to refund the patients.

‘Medicines sold at a markup’

The audit team said that since the hospital obtained Remdesivir and Tocilizumab through emergency procurement in 2021 and there was no public bidding involved, it should have used the purchase price as the basis for the retail price.

COA cited DOH Administrative Order No. 2020-0043 dated September 11, 2020, which provided that “no markup shall be allowed.”

“However, audit revealed that these medicines were sold at a markup contrary to the aforecited DOH directive,” the audit team said. 

A sample billing for 30 patients showed 198 vials of both Remdesivir and Tocilizumab were sold to patients with markups amounting to a total of P227,417.70.

Commission on Audit

The hospital purchased Remdesivir for prices of P5,500 and P7,400, but patients were charged P6,165 and P9,620, respectively.

Tocilizumab was obtained for P24,554 to P27,500 but patients were billed P26,396.70 to P29,490.

COA said the pharmacist at the hospital who responded to the audit observation took over her post only in 2021 but suggested that the former CGSH pharmacist might have overlooked the DOH directive when billing patients.

Exorbitant PPE bill

The auditors also found that 30 COVID-19 patients at the hospital were made to pay P12.74 million, nearly half of that amount or  P6.164 million for PPE costs alone.

COA said that based on its computation, the PPE cost should not have exceeded P891,792, which means the patients were overcharged by P5.272.

The auditors cited Department Memorandum No. 2020-0269 issued by the DOH on May 4, 2020, which set guidelines for fair PPE pricing in public and private health facilities to shield patients from profiteering, and to protect against hoarding which may lead to price manipulation.

CGSH, for its part, issued Hospital Order No. 2019-008 on October 15, 2020, which set the following PPE changes per shift: at least twice for non-COVID facilities, five times for COVID-19 wards, and eight times for the COVID ICU. 

State auditors said that upon review of the hospital policy, they found that “it is not in accordance with the guidelines prescribed” under the DOH memorandum. 

Because of the hospital order, the cost of PPE per patient at the CGSH COVID-19 ward reached P4,176 per day, while patients at the COVID-19 ICU were billed as much as P37,859.94 daily based on three shifts.

With four health care workers making eight PPE changes per shift, the COA said this meant that hospital staff changed their PPE every hour.

“It showed that the use of PPE was not optimized considering the shortage of supply of PPE,” the audit team said.

They cited the case of a COVID-19 patient who was confined for 40 days at the ICU, and was billed P2.187 million. Of that amount, more than half or P1.516 million was for PPE charges.

COA said the PPE bill should be recomputed to only P189,603. As such, the patient should be reimbursed P1.326 million.

In response to the audit findings, the CSGH medical center chief and the Pharmacy Unit officer-in-charge assured COA that its recommendations on the correction of pricing would be complied with in full, as well as the refund.

According to the audit report, the hospital chief said “that a Hospital Memorandum will be issued to the Billings and Claims Unit to review patients’ bills with overcharged drugs and medicines and PPE, particularly those who paid their hospital bills in cash, so that refund can be made, when necessary.” –

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