Solon questions PhilHealth’s supposed data discrepancies in Luzon hospitals

Isabela Representative Tonypet Albano on Thursday questioned PhilHealth over its supposed record discrepancies on the interim reimbursement mechanism in hospitals in Luzon provinces.

At a congressional inquiry of the Special Committee on North Luzon Growth Quadrangle, PhilHealth Area Vice President Walter Bacareza presented that the status of its IRM liquidation in Cordillera Administrative Region, Regions I and II, and Central Luzon is already at 99%.

The IRM is a system where PhilHealth pays hospitals and healthcare facilities in advance for insurance claims, to ensure that they could function during times of crisis.

However, Albano said he has records showing that the liquidation rate was not yet 99%.

"Gusto ko pong malaman bakit delayed po at hindi 99% na napapakita ninyo doon sa datos ninyo? [I want to know why it's delayed and not 99% in your data?] Your claim na 99% payment... I'm showing here na you are not correct. Why is there discrepancy?" Albano said.

In response, Bacareza admitted that there was discrepancy in the data.

"I agree po na may discrepancy, that is why we want to reconcile with each and every hospital po. So we will be on one page. Kasi on one side, nagsasabi kami na bayad sa amin eh, nagsasabi sila na hindi bayad, [we're saying that it's paid on our side but they're saying that it's not]," he said.

This further irked Albano as he warned PhilHealth that a further probe will be launched on this another issue.

"I would like to caution you that we will investigate further these claims because in light of the scams that has already rocked PhilHealth, you are still doing the same things and not paying all these claims that were due from 2020 up to now, 2021 May or June..." Albano said.

He gave PhilHealth one week to resolve the discrepancies.

Bacareza vowed that they would immediately reconcile their data.

Earlier, PhilHealth said that it has enough funds to cover the unpaid claims it owes to hospitals amid complaints that the state health insurer’s obligations are mounting to billions of pesos. — BM, GMA News