Three hospital and physicians’ groups on Saturday (Aug. 21) denounced Philippine Health Insurance Corp. (PhilHealth) Circular 2021-0013 as “an accusation towards health care providers” of supposed fraud.
The Philippine Medical Association (PMA), Philippine Hospital Association (PHA), and the Private Hospital Association of the Philippines, Inc. (PHAPI) said in a statement that this accusation is “unacceptable.”
PhilHealth released Circular 2021-0013 on Aug. 20 which aims to temporarily suspend the payment of hospital claims on the ground of apparent or probable cause, or on a mere suspicion.
The temporary suspension of payment of claims may last from 120 days to 240 days or 8 months.
“PhilHealth explains that it is mandated to take care of PhilHealth funds as it has always and emphatically announced in public,” the groups said. “But the health care providers view this baseless circular as another ploy to deny or delay the payment of claims.”
“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 groups added.
The health care groups then expressed their intention to review their engagement with PhilHealth.
“The bridge is bound to collapse, maybe it is time to review the engagement with PhilHealth and level the playing field,” they said.
“The PHA, PMA, and PHAPI, however, assures the public that its members will continue to serve the PhilHealth-covered patients while their members’ contracts with PhilHealth are still in effect until this December of 2021,” they added.
Meanwhile, PhilHealth assured that the circular will be implemented with due process.
The agency clarified that this policy has been in place since 2016, under PhilHealth Circular 2016-026. “With this new circular, the corporation introduced additional provisions that would ensure that due process is observed before any TSPC (temporary suspension of payment of claims) is finally issued so as to allay fears of alleged arbitrary investigations among our providers,” PhilHealth said in a statement on their website.
“The circular was issued in the spirit of proper fund management and fraud control. Fraud control is a basic tenet in managing funds. Hence, PhilHealth finds it imperative to implement measures to ascertain the security and sustainability of funds entrusted to it,” it added.
PhilHealth also said: “All health care providers can rest assured that this policy will be enforced with respect to due process and existing rules and regulations. Likewise, this policy will affect only providers engaged in fraudulent acts against the funds entrusted to the corporation by its members,” it said.
“PhilHealth assures its members and accredited providers that all good claims shall not be affected by this policy,” it added.
-Report from Rod Lagusad/PG – jlo
