COA: P20M PhilHealth refund did not reach Lung Center patients


    CASH refunds amounting to P20.3 million released by the Philippine Health Insurance Corporation (PhilHealth) for patients of the Lung Center of the Philippines have not been paid to the intended beneficiary members.

    This was revealed in the 2019 audit report on the government-owned hospital, which traced undistributed refunds dating back to 2002.

    “Of the total amount of P28.188 million received from the Philippine Health Insurance Corporation representing Medicare patients refunds …only P7.887 million or 28 percent was actually refunded as of December 31, 2019,” the Commission on Audit said.

    Under PhilHealth Circular No. 42 S. 2009, hospitals are required to release the money as patients’ reimbursements within 60 days upon receipt of the fund transfer from the PhilHealth.

    If the patient or his representative fails to claim the refund within this period, the hospital is required to voluntarily return the fund to the PhilHealth within 30 days without waiting for a demand.

    However, a review of the LCP’s General Ledger showed it continued holding on to the Medicare refund for the past 18 years.

    Records showed that in the last five years, refunds to PhilHealth members only ranged from 7 to 12 percent of the amount transferred from the state health insurer.

    While the Lung Center listed P2.445 million in “refunds” in 2019, investigation by the audit team revealed that these were something else.

    “The audit team noted that the total debit to Patient’s Refund PhilHealth account amounting to P2.445 million for CY 2019 was actually not a refund to patient-members but various adjustments to reclassify the said account,” it said.

    The COA recommended that the LCP notify all patient-members from its records to claim their refund or return the money to PhilHealth.

    It also required the hospital to submit its records pertaining to the supposed adjustments and overpayments for verification.

    The LCP management said it started cleaning up its records on such claims in 2015 which resulted in the adjustments totaling P2.445 million. It said the review for the earlier years up to 2014 has not been completed yet.