THE Philippine Health Insurance Corporation (PhilHealth) yesterday ordered the deferment of the implementation of the controversial Temporary Suspension of Payment of Claims (TSPC) circular amid strong opposition from hospital groups.
PhilHealth president and chief executive officer Dante Gierran said the implementation of Circular No. 2021-0013 “is suspended until further notice to address the concerns of health care providers.”
In a radio interview earlier yesterday, PhilHealth spokeswoman Shirley Domingo said the suspension will be in effect as they continue to hold dialogues with public and private hospitals.
The state-run health insurer’s circular suspended payment of claims of hospitals that are subject of investigations for alleged fraudulent or unethical acts, and/or abuse of authority.
This led to strong condemnation from hospital associations, with some threatening to discontinue their partnership with PhilHealth.
Domingo said policy is necessary to safeguard the funds of PhilHealth against fraudulent claims.
“Unfortunately, there are really reports of upcasing, non-COVID cases being claimed as COVID-19 cases. These are already being investigated as the relatives of patients themselves report to us,” she said.
“We are not saying that all hospitals commit fraud. There is no such claims. But if there is, we have to have a policy to address insurance fraud,” she added.
