PhilHealth: P45.1B paid to health facilities despite cyber attack

The Philippine Health Insurance Corporation (PhilHealth) has settled over P45 billion worth of claims by its partner health facilities last year, despite the cyber attack that hit the agency’s system a few months ago.

At a press briefing in Pasig City on Friday, PhilHealth president and CEO Emmanuel Ledesma Jr. said that the state health insurer paid a total of P45.1 billion to its partner health facilities as of December 31, 2023.

This amount of claims was paid to both private and government hospitals and health facilities covering the months of August to December 2023, “despite the cybersecurity incident in September,” according to Ledesma.

In September last year, PhilHealth’s system was hit by Medusa ransomware, with hackers demanding a $300,000 ransom for the stolen data.

The agency’s system—including its website, Health Care Institution (HCI) and member portal, and e-claims—were disabled or unplugged as part of security containment measures.

The state health insurer’s web-based system was restored in November.

“The situation has impacted the stakeholders’ receivables in the months of September and October, but PhilHealth was able to release payments of more than P12 billion in August and more than P10 billion in November,” Ledesma said.

“We have bounced back in our capacity to process payables and even exceeded our commitment to settle our obligations with our partner facilities in 90 days,” he added.

The PhilHealth chief also said that the agency’s system is now stronger.

“We have strengthened our system. It’s safe to assume hindi na ‘yan mangyayari ulit (it won’t happen again),” Ledesma said, referring to the September 2023 ransomware attack on PhilHealth’s system.

He appealed to partner health facilities to submit good claims and comply with the policies to avoid returns or denied claims, for we are bound by the auditing rules and regulations of the government. 

“We want to assure our partners that PhilHealth's doors are always open for communication and reconciliation of claims records,” he said. 

“As we move forward, we plan to implement the following initiatives to address bottlenecks in claims processing. As an immediate solution, we will implement the claims system override support or SOS this month,” he added.

Within the year, Ledesma said PhilHealth is set to launch various modules, such as the cloud-based application system deployment, online filing for claims on motion for recommendation, and the adjustment module.

“By 2025, as part of our long-term solution, we intend to deploy automated e-claims submission and processing via a cloud-based application system,” he said. —VBL, GMA Integrated News