Lung Center flagged for P19.5-M unrefunded PhilHealth claims

State auditors have flagged the Lung Center of the Philippines (LCP) for failing to refund P19.5 million worth of reimbursement claims from the Philippine Health Insurance Corporation (PhilHealth) to eligible patients.

In its latest report, the Commission on Audit (COA) said only 31% or P8.9 million out of the P28.3-million PhilHealth refunds for 2002 to 2020 had been refunded as of December 31 last year.

The refunds were a result of under-deduction or non-availment of benefits by patients.

“These are the monies of the patient-members and should be given back to them,” state auditors said.

COA also noted that deductions from the account Patient’s Refund-PhilHealth amounting to P978,708 were “actually not refunded to patient-members” but instead reclassified to the Refund-Overpayment account.

State auditors recommended that LCP refund the remaining payments to patients or return the amount to PhilHealth.

They also called on the hospital’s accounting division to analyze and make adjustments to the Patient’s Refund-PhilHealth account “to reflect the correct amount to be refunded to concerned patient-members and the amount to be returned to PhilHealth.”

The LCP management said that while the tasks are “very tedious,” they managed to bring down the unrefunded claims from P20.3 million in 2019 to P19.5 million in 2020.

Denied claims

COA also found that 931 regular reimbursement claims worth P13.5 million were denied due to the submission of inconsistent data, late refiling, and expired validity, among others.

“[This] resulted in the accumulation of uncollectibles from PhilHealth and loss of income which could have been used to augment the requirement of LCP for its maintenance and other operating expenditures including repair of existing hospital facilities,” it said.

COA recommended that LCP management adhere to guidelines for claims processing, evaluate denied claims and explore remedies for PhilHealth’s reconsideration, conduct regular reconciliation with PhilHealth for unpaid claims, and continuously train staff.

The hospital management said it usually submits motions for reconsideration for denied claims “duly supported with required documents.”

LCP also vowed to “strictly adhere” to guidelines and “be very careful” in claims processing to avoid denials. — BM, GMA News