PhilHealth: Caution vs. fraud causes delays in payment of hospital bills

Delays in Philippine Health Insurance Corporation's payments of some of its hospital obligations were due to the strict process of ensuring that only authentic claims  would be paid for, a PhilHealth official said Thursday.

PhilHealth CEO Ricardo Morales said the state health insurer is being cautious to avoid paying for fraudulent claims such as the recent controversy over “ghost dialysis” in which its partner WellMed Dialysis & Laboratory Center Corp. supposedly processed and benefited from claims deceased or "ghost" patients.

Some 600 hospitals reportedly threatened to forego renewal of their PhilHealth accreditation in 2020 due to unpaid claims in billions of pesos.

“We want to err on the side of caution. You know what happened with WellMed,” Morales said in an interview on ANC Thursday.

According to Morales, the P2.5-billion unpaid reimbursement to hospitals is not even a ‘huge amount’ for PhilHealth to run away from it, noting that they actually spend P3.5 billion a week.

“This is not a large amount for us. We're still being investigated by four government agencies. We want to be careful now,” he said.

Morales claimed that some of the 600 hospitals under the Private Hospitals Association of the Philippines Inc. (PHAPi) denied reports that they will cut ties with PhilHealth.

He added that only PHAPi President Dr. Rustico Jimenez made the threat, which he said a threat not to PhilHealth but to the Filipinos who need health care.

According to him, as of August this year, PhilHealth has already paid some P75 million in claims, adding that the state health insurer has allocated this year a budget for improving their interconnection system for the processing of claims.

Also he noted that some doctors have already been suspended due to the corrupt activity. —Joviland Rita/LBG, GMA News