PhilHealth has yet to settle P18B claims of private hospitals – solon


    PAY expensive medical bills or find treatment elsewhere.

    Cagayan de Oro City Rep. Rufus Rodriguez said ailing Filipinos could face this nightmare scenario in the event that private hospitals defer their accreditation with the Philippine Health Insurance Corp. (PhilHealth) because of billions in unsettled claims.

    The Mindanao lawmaker said PhilHealth’s obligations have reached P18 billion representing unpaid reimbursement claims of hospitals in the previous two years.

    “This is very urgent specially because we are still facing this COVID-19 pandemic and we all need the full operations of our hospitals with the necessary medical personnel. We don’t want our hospitals to close, downscale services, or lay off medical personnel because of non-payment of claims by PhilHealth,” he said.

    Rodriguez noted claims by the Philippine Hospitals Association of the Philippines (PHAP) that Philhealth owed its members P14 billion as of December 2018 and P4 billion at the end of 2019.

    The PHAP is composed of 733 hospitals representing 44,700 beds nationwide.

    “One of the reasons why many private hospitals are struggling to respond to the COVID-19 pandemic is because they are running out of funds. Many of them have had to obtain emergency loans to sustain their operations,” Rodriguez said.

    Likewise, the financial difficulties of the said hospitals have been cited as their reason for retrenching some of their employees to sustain operations.

    “As an example, the University of Santo Tomas Hospital has reduced its manpower and implemented cost-efficiency measures following ‘significant losses’ inflicted by the COVID-19 pandemic and the delay in Philhealth payments,” Rodriguez said.

    He quoted UST Hospital medical director Marcellus Francis Ramirez as saying the delay is “an average of 5-6 months” and that the hospital’s receivables from Philhealth stood at more than P180 million.

    “As a result of unpaid claims, PHAP members have signified their intention to hold back or hold in abeyance their accreditation with Philhealth, which would be very detrimental to the Filipino people,” he said.

    He noted that Philhealth has been steadfast in denying that it has unsettled claims with UST and other hospitals.

    Rodriguez also disclosed that a number of private hospitals in Mindanao have been stripped of accreditation over pending cases, mostly in connection with allegations of suspicious billing charges.

    Although Rodriguez did not name the hospitals, he said the complaints centered in “upcasing,” or the fraudulent practice of declaring a different ailment for a patient in order to jack-up reimbursements.

    The lawmaker said the hospitals lamented that their accreditations were terminated even if no decision has been reached on the complaints against them. They added that they were not given the opportunity to be heard in a formal hearing.