Senator Imee Marcos has called for a review of PhilHealth’s “abuse of its quasi-judicial powers,” as hospitals threaten to walk out on the state health insurance agency over allegedly delayed reimbursements since last year.
Marcos said PhilHealth’s plan to implement a temporary suspension of payment of claims (TSPC) before the end of August “highlights the need to curtail the agency’s overarching control over hospital fraud, payments and sanctions.”
“PhilHealth’s simultaneous investigation and suspension of reimbursement claims is coercion, not an anti-fraud effort. Allegations of attack-and-collect, of false fraud charges, and suspension blackmail by PhilHealth Legal have been heard many times in the past,” Marcos explained.
“I know PhilHealth chairman (Dante) Guierran to be a competent and upright public servant. But some officials in his Legal department have been known to be the opposite,” Marcos pointed out.
“Billions in dormant PhilHealth funds should be released and put to work ASAP. These are not meant to just keep earning interest in the bank during a global health crisis,” Marcos added.
Marcos expressed concern that some 96 million beneficiaries of government-subsidized healthcare may be left to pay all their hospital bills, if the TSPC pushes health care institutions to disengage from PhilHealth by the end of the year.
“Health insurance premiums being paid by government and private sector employees, overseas Filipino workers, indigents, senior citizens, self-earning or informal workers, as well as their dependents, will be rendered useless if hospitals decide that the TSPC is the last straw and walk out on PhilHealth,” Marcos warned.
Based on direct complaints reaching Marcos’s office, hospitals see the TSPC as “very thinly disguised coercion and harassment” rather than a means to protect PhilHealth from irregular hospital claims.
“It could not be worse-timed amid the emergence of Covid-19 variants and new waves of rising infection,” Marcos said.
PhilHealth’s mechanism to claim refunds, file cases, and revoke the accreditation of health care institutions (HCIs) “obviates the need for TSPC” to discourage upcasing, Marcos said, referring to the anomalous practice of tampering with patients’ data and distorting the gravity of a disease to pad the value of reimbursement claims.
“And in the upcasing incidents evidenced in the past, collusion not between hospitals but involving PhilHealth officials themselves has been proven. Laging kasabwat ang PhilHealth sa upcasing raket na ‘yan! (Philhealth is always in cahoots in that upcasing racket!)” Marcos said.
As it is, PhilHealth has not even met its promise to reimburse 60% of the value of hospital claims via the newly launched Debit-Credit Payment Method (DCPM), Marcos said, based on direct complaints from private hospitals and hospital associations reaching her office.
“Some provincial hospitals have not even received 1% of their claims,” Marcos cited.
“Hospitals need to maintain or even increase their healthcare capacities during this crucial period. PhilHealth must stanch their financial hemorrhage by speeding up reimbursements soon,” she added.