PhilHealth denies paying out P600-M in denied claims to hospitals

The Philippine Health Insurance Corp. (PhilHealth) on Friday belied allegations that it had paid out P600 million in denied claims to hospitals under an amnesty program.

“The Philippine Health Insurance Corp. clarifies that there is no truth to the report that P600 million in amnesty have been paid out to hospitals for denied claims,” PhilHealth Executive Vice President and Chief Operating Officer Arnel de Jesus said in a statement.

“The claims in question have been denied payment due to late filing and refiling,” de Jesus added.

Surigao del Norte Rep. Robert Ace Barbers alleged that PhilHealth approved the grant of P600 million in claims to hospitals last May 14 despite these claims being rejected from 2011 to 2019 by the PhilHealth’s Protest Appeals and Review

Barbers argued that each claim should have undergone detailed scrutiny and evaluation before being reconsidered, and that the evaluations of claims from two to nine years ago appeared to be anomalous.

The PhilHealth earlier said it would review and possibly pay some P600 million in claims that had previously been denied.

However, de Jesus explained that the possibility of these claims being considered for payment under an amnesty program were “still subject to issuance of a signed Board resolution as well as specific guidelines thereafter.”

“All of these have not yet been realized, and therefore no fund releases to speak of,” the PhilHealth official noted.

“PhilHealth has committed to provide Congress with the documents pertinent to this matter to completely shed light on the issue. The Agency defers to their good judgment to see that no such amount has been paid out yet,” de Jesus added.

PhilHealth and its officials are under investigation over the alleged overpriced purchase of an information technology system worth over P2 billion.

In a Senate hearing, resigned anti-fraud officer Thorsson Montes Keith claimed that the PhilHealth "mafia," allegedly composed of the executive committee, stole some P15 billion through fraudulent schemes such as the interim reimbursement mechanism (IRM).

PhilHealth has since denied such claims and has since suspended the IRM.

Under its mandate, PhilHealth is tasked to administer the National Health Insurance Program which aims to provide health insurance coverage and ensure affordable, acceptable, available, and accessible health care services for all citizens of the Philippines.

“Time and again, PhilHealth has committed itself to cooperating to all the investigations and it will continue to do so to ferret out the truth for the benefit of the Filipino public that it serves,” de Jesus said. — DVM, GMA News