COA: Lung Center of the Philippines yet to refund P22.6M to PhilHealth patient-members

The Commission on Audit (COA) has flagged the Lung Center of the Philippines (LCP) for its supposed failure to refund more than P22.6 million worth of reimbursement claims to eligible members of the Philippine Health Insurance Corporation (PhilHealth) for 16 years.

In its annual audit report, the COA said the LCP only refunded P5.4 million out of the total P28 million it collected from PhilHealth between 2002 to 2018. The yearly unrefunded amounts, it said, ranged between P132,710 to P5.68 million.

State auditors said the lapses of the LCP "deprived the concerned patient-members of their benefit."

They said this was also contrary to PhilHealth Circular No. 42, series of 2009, which requires accredited health care providers to refund the benefit claims of members within 60 days after its receipt from the state insurance firm.

"The patients refund from PhilHealth is a benefit payment that should be reimbursed by the accredited hospital to the patient-member for a specific confinement period," the COA said.

"The refund resulted from either an under-deduction or non-availment of benefits at point-of-service due to various circumstances at the time of hospitalization," it added.

The COA said the LCP should have remitted the unclaimed refunds back to PhilHealth within 30 days as stated in PhilHealth Circular No. 42, series of 2009.

The commission urged the public hospital to "exert all efforts" in ensuring the refund to PhilHealth members.

LCP management told the COA during the exit conference that it has assigned personnel to review the amounts in the PhilHealth Medicare Patients Refund account to ensure the accuracy of the refunds.

It said eligible claimants will be notified of their refunds, but vowed to remit the funds back to PhilHealth in case the member is no longer located.

The COA said it will monitor the full compliance of the LCP for 2019. —KBK, GMA News