COA: Palawan hospital overcharged COVID patients

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A GOVERNMENT hospital in Palawan overcharged COVID-19 patients for the cost of medicines and personal protective equipment (PPE) worn by doctors, nurses, and other attending medical personnel, according to government auditors.

The 2021 audit report on the Department of Health said the Culion Sanitarium and General Hospital (CSGH) located in Culion, Palawan made COVID-19 patients pay P5.27 million over the normal cost of PPEs and overcharged them by P227,417.70 on medicines.

Because of this, the Commission on Audit has recommended that the Secretary of Health order the Medical Center Chief (MCC) of the CSGH to issue refunds to paying patients, who were made to cough up more than the fair cost of their treatment.

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The audit team said the hospital obtained Remdesivir and Tocilizumab through emergency procurement in 2021.

Since there was no public bidding involved, auditors said the purchase price should have been used as the basis for the retail price in accordance with DOH Administrative Order No. 2020-0043 issued on September 11, 2020 which specifically provided that “no mark-up shall be allowed.”

“However, audit revealed that these medicines were sold at a mark-up contrary to the aforecited DOH directive,” the audit team pointed out.

A sample billing for 30 patients showed 198 vials of both Remdesivir and Tocilizumab were sold to patients with mark-ups totaling P227,417.70.

Remdesivir was purchased at P5,500 to P7,400 but was charged to patients at P6,165 to P2,220.

On the other hand, Tocilizumab which was obtained at P24,554 to P27,500 was billed at P25,396 to P29,490.

The CSGH pharmacist who answered the audit observation only assumed the post in November 2021 but explained that her predecessor might have overlooked the DOH AO No. 2020-043 when billing patients to medicines at a mark-up.

Likewise, auditors found 30 patients in the hospital’s COVID ward and COVID Intensive Care Unit (ICU) who were billed P12.74 million for their entire treatment cost, which included P6.164 million for PPE alone.

The COA said by its own computation the total PPE charge for all 30 patients should not have exceeded P891,792, which means the difference of P5.272 million was tagged as “overcharge.”

Auditors noted that anticipating a need to regulate the pricing and charging of PPE to protect patients from profiteering, the DOH had issued Department Memorandum No. 2020-0269 dated May 4, 2020 setting guidelines for fair pricing of PPE in health facilities.

However, the audit team noted that CSGH issued Hospital Order No. 2019-008 dated

October 15, 2020 which set PPE changes per shift of at least twice for non-COVID facilities, five times for COVID-19 wards, and eight times for the COVID ICU. Auditors pointed out the number of PPE changes was not considered in the DOH computation under its Department Memorandum.

Because of the said hospital order, the cost of PPE per patient in the COVID-19 ward reached P4,176 per day while those in the COVID-19 ICU went as high as P37,859.94 daily based on three shifts.

With four health care workers (HCWs) making eight PPE changes per shift, the COA noted that it would mean that each hospital personnel were changing PPE every hour.

“It showed that the use of PPE was not optimized considering the shortage of supply of PPE,” the audit team noted.

One patient whose confinement dragged for 40 days at the COVID-19 ICU was billed P2.187 million, of which P1.516 million was for PPE charges.

The COA said the PPE bill should be recomputed to only P189,603 hence the amount of P1.326 million should be reimbursed to the patient.

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In reaction to the audit findings, the CSGH MCC and the OIC-Pharmacy Unit Head assured the COA that its recommendations on the correction of pricing would be complied with in full, particularly on the matter of refund.

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