PhilHealth

PhilHealth urged to review, suspend new circular on claims payment

Bonz Magsambol
Health Secretary Francisco Duque III, who chairs the PhilHealth board, says that they are 'sensitive with the plea,' and they will take this up in their board meeting

Lawmakers on Tuesday, August 24, urged the Philippine Health Insurance Corporation (PhilHealth) to review and suspend a new circular on the temporary suspension of hospitals payment claims that are under investigation.

At a House health panel hearing, Nueva Ecija 1st District Representative Estrellita Suansing said that the new circular would lead to hospital closures at a time when the country’s healthcare system is dealing with a fresh surge in COVID-19 infections driven by the Delta variant.

“It’s a pandemic. Kapag marami ang mga hospitals na magclose, ano ang mangyayari sa mga Pilipino (What will happen to Filipinos if more hospitals will close)?” Suansing asked.

Suansing moved that the committee “strongly urge PhilHealth to review and possibly suspend Circular no. 2021-0013 without any prejudice to any legislative remedy or measure.”

Her motion was seconded by a number of lawmakers present in the hearing.

On Friday, August 20, the state health insurer released PhilHealth Circular No. 2021-0013 “suspending payment of claims that are subject of  investigations pertaining to fraudulent, unethical acts, and/or abuse of authority.”

Circular No. 2021-0013 is a conditional temporary suspension of payment of claims (TSPC) that would take effect for 120 days.

Following PhilHealth’s announcement, hospital groups said that they were “disengaging” from PhilHealth. This means that PhilHealth members cannot avail of PhilHealth benefits when they go to their member-hospitals “for the meantime.” 

Earlier on Tuesday, the Philippine Hospital Association said that PhilHealth owes hospitals P13.6 billion in denied claims, with P13 billion to P16 billion in-process claims, and P46 billion Return to Hospital (RTH).

In its defense, PhillHealth said that the circular was issued “in the spirit of proper fund management and fraud control.”

“Fraud control is a basic tenet in managing funds. Hence, PhilHealth finds it imperative to implement measures to ascertain the security and sustainability of funds entrusted to it,” the state health insurer said in a statement.

In the same hearing, Health Secretary Francisco Duque III, who chairs the PhilHealth board, said that they are “sensitive with the plea,” and that they will take this up in their board meeting.

“It’s a management call. We will look at at the policy gaps that there might be in the implementation of this circular,” he said.

In 2020, as the Philippines battled the coronavirus pandemic, lawmakers held marathon investigative hearings into alleged rampant corruption in PhilHealth.

Thorrsson Montes Keith, who resigned as PhilHealth anti-fraud legal officer in late July 2020, alleged that members of PhilHealth’s executive committee “misspent or pocketed” P15 billion.

PhilHealth urged to review, suspend new circular on claims payment

It took PhilHealth seven months to approve a circular on COVID-19 benefit packages for patients needing hospitalization. – Rappler.com

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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.