PhilHealth temporarily withdraws circular on suspension of claims payment

Published August 29, 2021, 7:57 PM

by Analou de Vera

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The Philippine Health Insurance Corporation (PhilHealth) said it is temporarily stopping the implementation of the controversial “Temporary Suspension of Payment of Claims” (TSPC) policy.

PhilHealth Circular No. 2021-0013 which contains the guidelines for the implementation of the TSPC was issued on Aug. 20.

“This is to inform all concerned stakeholders that the implementation of PhilHealth Circular No. 2021-0013 is suspended until further notice to address the concerns of healthcare providers,” said PhilHealth President and Chief Executive Officer Dante Gierran in a statement on Sunday, Aug. 29.

In a radio interview on Sunday, PhilHealth Spokesperson Shirley Domingo said they are currently in talks with the different hospital groups to review the controversial circular.

“We are suspending it, in the meantime, while we continue to hold talks with them and we conduct a review of the circular,” said Domingo.

The circular drew criticisms from hospital groups, prodding them to issue a statement that they are eyeing to cut their ties with PhilHealth.

“The bridge between the healthcare providers and PhilHealth now has serious cracks caused by a feeling of mistrust by PhilHealth against healthcare providers. The bridge is bound to collapse, maybe it is time to review the engagement with PhilHealth and level the playing field,” read the joint statement released by the Philippine Hospitals Association (PHA), Philippine Medical Association (PMA), and Private Hospitals Association of the Philippines (PHAPi) last Aug. 21.

The state-health insurer said that the TSPC is “a payment preventive measure against HCPs (healthcare providers) that are subject of investigation based on the credible and verifiable report by the Corporation or other duly authorized government agencies, owing to apparent and probable presence of fraudulent act, unethical practices, and /or abuse of authority.”

Domingo said that the objective of the circular is to address insurance fraud.

“Unfortunately, there are really reports of upcasing, non-COVID cases being claimed as COVID-19 cases. These are already being investigated,” she said.

“We are not saying that all hospitals commit fraud. There is no such claims. But if there is, we have to have a policy to address insurance fraud,” she added.

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