Alleged debts of PhilHealth to some hospitals absent in state insurer’s data, spokesperson says

The alleged unpaid claims of the Philippine Health Insurance Corporation (PhilHealth) to some hospitals do not appear in the database of the state insurer, according to its spokesperson.

In an interview on GMA Network’s Unang Hirit on Tuesday, PhilHealth spokesperson Dr. Shirley Domingo said some forms for reimbursement were returned to hospitals due to lack of documentation.

“Ngayon, meron ibang claims naman, either na-return to hospital dahil sa kakulangan, either sa documents o may kulang doon sa nilagay. So binabalik ‘yun sa hospital,” Domingo said.

Aside from this, Domingo said some claims were altogether denied by PhilHealth.

“Hindi po natin alam exactly ang sinasabi nila kasi 'yung data na sinabi nila ay hindi nakikita sa aming mga data din,” she said.

Domingo made the statement after the Private Hospitals Association of the Philippines Inc. (PHAPi) said that around 300 hospitals are in danger of shutting down due to the alleged unpaid claims.

“Since January, we have paid already around P52 billion to our hospitals. Malaki po ang bayad natin kasi we process around 1 million claims a month,” Domingo said.

She pointed out that the claims for reimbursement that were denied by PhilHealth should not be counted as unpaid claims.

“Mag-account reconciliation tayo. Huwag nilang isisi naman ang pagsara nila o financial woes nila only on PhilHealth because there are a lot of reasons kung bakit bumababa rin ang kanilang earning,” she said.

“Ang tao takot pumunta sa hospital kaya bumababa ang admission nila because of COVID. Natatakot sila mahawa sa COVID,” she said.

PhilHealth earlier said it has already disbursed P52.53 billion this year to hospitals.

It said payment of claims as of May amounted to P38.6 billion, including P4.74 billion paid through the accelerated return to hospital (RTH) initiative, while P13.93 billion was released under the interim reimbursement mechanism.

PhilHealth president Ricardo Morales earlier denied that the state insurer owes UST Hospital over P180 million in expenses for patients in 2019.

Morales said PhilHealth has paid P2.1 billion since 2015 and P300 million in 2019 to UST Hospital. The state insurer also paid the hospital P85 million in advance for coronavirus disease 2019 (COVID-19) response this year, aside from the regular dues.

PhilHealth on Monday also assured the public that it has enough funds to sustain operations amid the COVID-19 pandemic, even as its top official recommended the delay of the implementation of the Universal Health Care Law.

Presidential spokesperson Harry Roque Jr. earlier said he would reveal what he claimed were “new anomalies” in PhilHealth, slamming the leadership for their supposed failure to go after corrupt officials.

Morales denied corruption allegations and said there are no large-scale collusion efforts to defraud the corporation. —Joviland Rita/KG, GMA News