PhilHealth urged to review circular blamed for delaying payment of hospital claims

Published August 24, 2021, 4:02 PM

by Hannah Torregoza 

The House Committee on Health on Tuesday, August 24 called on the Philippine Health Insurance Corp. (PhilHealth) to review and possibly suspend its controversial circular that calls for a temporary suspension of claims payment for hospitals who would be found having fraudulent claims.

This was after the panel headed by Angelina “Helen” Tan approved Nueva Ecija Representative Estrellita Suansing’s motion calling on PhilHealth to suspend Circular No. 2021-0013 which private hospitals deemed a “severe financial distress” to them.

“I don’t think this is the right time to come up with a circular. Therefore, I would like to suggest to my colleagues to suspend this circular. I so move madam chair,” Suansing said during the virtual hearing.

Suansing’s motion was seconded by Rep. Mikki Violago. Suansing insisted it should be done because of the COVID-19 pandemic.

“It’s pandemic madam chair. Alam mo pag marami ang mga hospitals that will close, Diyos ko, Madam Chairman, anong mangyayari sa mga Pilipino, sa mga constituents natin, sa buong Pilipinas. This is not the right time to come up with a circular,” she said.

Tan, in response, urged Suansing to file a motion motu propio asking that the Circular No. 2021-0013 be suspended, which the panel immediately approved.

PhilHealth’s acting executive vice president and chief operating officer Eli Santos defended the agency and explained why they need to follow through with the implementation of the resolution saying the state health insurance agency needs to uphold auditing procedures in the processing of claims payment of hospitals to avoid being held criminally liable for income losses.

The circular provides guidelines on the issuance of Temporary Suspension of Payment of Claims (TSPC) which he said is a preventive measure against healthcare providers that are subject of investigation.

Santos said that while the quick solution to the clamor of the hospitals is to pay all claims that are unpaid, PhilHealth would be remiss in observing proper auditing rules.

“As Secretary (Francisco) Duque said, the easiest thing for PhilHealth to do is to pay all these claims that are unpaid,” Santos pointed out.

“However, there are auditing and accounting rules that PhilHealth must also observe. If not we’ll be charged, Madam Chair,” he stressed.

“My personal view on this is that we will assist hospitals through consultation, reconciliation and all strategies so that they will submit more or less perfect claims. So that there’s nothing more to do by PhilHealth except to pay those claims madam chair,” the PhilHealth official added.

He also said the agency is already implementing strategies to improve its own policies, its own information technology (IT) systems to make transactions faster and augment its own personnel.

“So PhilHealth is implementing all these things and doing its best to address these present problem,” he added.