PhilHealth circular vs 'fraudulent' healthcare providers just a 'ploy' to deny or delay claims, say health groups

Published August 21, 2021, 6:57 PM

by Ellalyn De Vera-Ruiz


Medical and hospital associations on Saturday, Aug. 21, called the decision of the Philippine Health Insurance Corporation (PhilHealth) to suspend the payment of hospital claims as just a tactic to deny or delay the payments.

“PhilHealth’s accusation against health care providers of supposed fraud is just unacceptable. To bolster its accusation against health care providers, PhilHealth came up with Circular 2021-0013,” the Philippine Health Association (PHA), Philippine Medical Association (PMA), and Private Hospitals Association of the Philippines (PHAPI) said in a joint statement.

The statement was signed by presidents Jaime Almora of PHA, Benito Atienza of PMA, and Jose Rene De Grano of PHAPI.

Based on a circular issued on Friday, Aug. 20, PhilHealth said a “temporary suspension of payment of claims” (TSPC) against healthcare providers (HCPs) that are “subject of investigations pertaining to fraudulent” claims will be implemented.

PhilHealth further explained that the TSPC is “not a penalty but a preventive measure to avoid the loss or wastage of funds due to fraudulent acts, unethical acts, and abuse of authority.”

However, the health groups said the circular “aims to suspend the payment of hospital claims on the ground of apparent or probable cause, or on a mere suspicion.”

“The health care providers view this baseless circular as another ploy to deny or delay the payment of claims,” they said, noting that the TSPC may last from 120 days up to 240 days.

“The bridge between the health care providers and PhilHealth now has serious cracks caused by a feeling of mistrust by PhilHealth against health care providers. The bridge is bound to collapse, maybe it is time to review the engagement with PhilHealth and level the playing field,” the groups said.

Despite PhilHealth’s decision, PHA, PMA, and PHAPI assured the public that its members will continue to serve the PhilHealth-covered patients while their members’ contracts with PhilHealth are still in effect until December 2021.