Congress to dig deeper into P14-B advanced payment made by PhilHealth to hospitals

The House of Representatives will dig deep into the P14 billion that the Philippine Health Insurance Corp (PhilHealth) paid in advance to hospitals for COVID 19 despite the suspension of additional fund releases.


Anakalusugan Rep. Mike Defensor, chairman of the House Committee on Public Accounts, said the congressional inquiry will initially prioritize the P1 billion that PhilHealth has claimed to have already been liquidated.

Supporting documents for expenditures will be scrutinized, said Defensor.

“We will examine those payments in detail for any sign of fraud and/or overpayment. We have already asked Philhealth to submit all supporting documents,” said Defensor.

The alleged imbalance in the distribution of the funds, with the Southern Philippines Medical Centerin Davao City getting the biggest amounts among hospitals in the country, was raised during a previous committee hearing.

In the same hearing, Commission on Audit Director Cleotilde Tuazon raised an issue over the violation of audit regulations by PhilHealth. She noted that liquidation of disbursements were delayed, with only 6.8 percent or P1 billion of the P14.7 billion advance payment granted to hospitals, being liquidated.

Defensor said COA estimates that there is at least a 20-percent “overpayment” in the case of package rates.

“Twenty percent of P14 billion is P2.8 billion. That is the potential loss from the amount PhilHealth advanced to hospitals. We will watch out for any sign of overpayment or excess payment or claims in the documents we have asked from Philhealth,” he said.

He said health facilities should not make a reimbursement/payment claim for a “package rate” of almost P44,000 for mild pneumonia if it treated a patient only for cough, colds, and fever.

“Theoretically, a hospital can do that, and it happened in many cases in the past. But now we are watching,” Defensor added.

“We hope to get by next week the supporting papers which should indicate the amounts advanced, the recipient-hospitals, amounts liquidated, number and classification of new coronavirus disease cases, number and names of patients, medicines given, and the treatment patients received,” said Defensor.

PhilHealth has reported that it has allocated P30 billion for COVID-19 cases, of which P14 billion has been advanced to health facilities.

Defensor said the reported suspension of additional releases apparently covers the remaining P16 billion.

He warned hospitals to be careful in liquidating and treating as payment the P14 billion PhilHealth has advanced to them.

The state-owned health insurance earlier set “case/package rates” for COVID-19 cases: P43,997 for mild pneumonia, P143,267 for moderate pneumonia, P333,519 for severe pneumonia, and P786,384 for critical pneumonia/coronavirus disease.