PhilHealth pauses circular on suspension of hospital claims payment

Lawmakers earlier said the PhilHealth circular would lead to hospital closures in the middle of the COVID-19 pandemic

The Philippine Health Insurance Corporation (PhilHealth) paused the implementation of a new circular that suspended the payment of hospital claims which are under investigation.

PhilHealth President Dante Gierran announced in an advisory on Sunday, August 29, that PhilHealth Circular No. 2021-0013 or the Temporary Suspension of Payment of Claims “is suspended until further notice to address the concerns of healthcare providers.”

“All other issuances to address fraud shall remain in effect,” added Gierran.

The circular, released on August 20, suspended the payment of claims “that are subject of investigations pertaining to fraudulent, unethical acts, and/or abuse of authority.”

Lawmakers earlier called on PhilHealth to review and suspend the enforcement of the circular, arguing that it would lead to hospital closures in the middle of the COVID-19 pandemic.

Hospital groups also said they were “disengaging” from PhilHealth due to the new policy. This means that PhilHealth members cannot avail of the agency’s benefits when they go to these groups’ member-hospitals “for the meantime.”

PhilHealth previously said the circular was issued “in the spirit of proper fund management and fraud control.” –