A House committee on Tuesday approved a motion urging the Philippine Health Insurance Corp. (PhilHealth) to review and possibly suspend its circular on the temporary suspension of claims payments "without prejudice to any legislative remedy or measure that may be filed by the committee."
The House Committee on Health, chaired by Rep. Angelina Tan of Quezon, approved a motion of Rep. Estrellita Suansing of Nueva Ecija urging PhilHealth to suspend its Circular 2021-0013.
It provides guidelines on the issuance of Temporary Suspension of Payment of Claims (TSPC) as a preventive measure against health care providers that are subject of investigation.
Meanwhile, PhilHealth’s share in the 2022 national budget will be short by P30 billion compared to the Department of Health’s original proposal.
At the same House panel hearing on Tuesday, Health Secretary Francisco Duque III told lawmakers they originally proposed a P110 billion budget for PhilHealth in 2022, but only P80 billion was approved in the President’s budget.
“So, there is a deficit of about P30 billion," Duque said.
This developed as the president of the Philippine Hospital Association (PHA) said Tuesday PhilHealth owes its members an average of P7 million each.
PhilHealth, however, said it only owed P12.9-billion worth of claims in different stages of processing, contrary to the P86 billion claim of hospitals.
PHA president Dr. Jaime Almora said the P86 billion is the total amount that hospitals spent on patients without reimbursement from PhilHealth. The PHA has some 1,100 members.
PhilHealth owes hospitals some P13.6 billion in denied claims, with P13 billion to P16 billion in-process claims, and P46 billion Return to Hospital (RTH) claims, according to Almora.
Also, Senator Richard Gordon said PhilHealth still owed the Philippine Red Cross P570 million for the COVID-19 tests conducted by the humanitarian organization.
“Before it was nearly P1 billion, but they were able to bring it down. I'm grateful but still it’s debt,” Gordon, the current PRC chairman, said in an online press conference.
Last October, the PRC stopped conducting COVID-19 tests chargeable to PhilHealth due to the state health insurer’s inability to settle its outstanding balance, then at P930.9 million.
It resumed testing weeks later after PhilHealth settled a portion of the balance.
PhilHealth acting senior manager Dr. Lambert David said the temporary suspension of payment of claims was merely updated and the recent circular was “issued in the spirit of proper fund management and fraud control.”
PhilHealth assured its members and accredited health care providers that all valid claims would not be affected by the policy, he added.
PhilHealth president Dante Gierran said that "all health care providers can rest assured that this policy will be enforced with respect to due process and existing rules and regulations."
But the PHA and other groups voiced concern over the payment suspension, saying it would hurt not only health care providers but patients as well.
Almora said PhilHealth has yet to settle billions of pesos in reimbursements, adding that hospitals are particularly wary that their COVID-related claims will be declared as "fraudulent”, and the tag could unfairly taint the reputation of hospitals.
The hospital groups had previously declared that they were considering "disengaging" from PhilHealth and warned that the bridge between the two sides was “bound to collapse.”
Almora said the health care providers do not question the content of the circular but questioned its timing, coming as it does amid the health crisis brought about by the COVID-19 pandemic.
During the hearing, he read a public statement of health care providers regarding their distress call to review their engagement with the PhilHealth and continue the negotiation.
As a compromise and to improve their relations with PhilHealth, the health care provider groups called on PhilHealth to avoid "biased and unfair evaluation of reimbursement claims by using qualified and knowledgeable claim evaluators."
Also, a "fruitful’ dialogue transpired among PhilHealth management, the Department of Health, and hospital associations to resolve issues raised on Circular No. 2021-0013 which suspended payment of claims over fraudulent, unethical acts, and/or abuse of authority"
Senator Christopher Go said concerned agencies could come up with a win-win solution that would not hamper or adversely affect services needed by ordinary Filipinos during this public health emergency.
The senator, chair of the Senate health committee, hoped for positive results “so that the health and welfare of Filipinos will not be compromised.”
PhilHealth President Dante Gierran said all health care providers “can rest assured that this policy will be enforced with respect to due process and existing rules and regulations."
But PhilHealth had imposed policy after policy that posed problems for hospitals such as the payment recovery policy, where PhilHealth would reimburse claims but later take them back, PHA’s Almora said.
"They complained, is this a strategy to not pay us? They're not paying us and also calling us frauds,” he said. "We're like carabaos. They are hit while not being fed. We're the beast of burden in this situation,” he said.
A senior congressman said Gierran should not have been appointed to head PhilHealth for lack of knowledge of how the agency operates.
Quezon Rep. Tan, chairman of the House Committee on Health, said after a hearing on the problems besetting PhilHealth: “If you’re going to ask me (if Gierran can do the Philhealth job), straightforward? I think [no].”
“I’ll be honest to you because] during our hearing on Tuesday, when we asked on the issue on inconsistencies on the circular on the benefit package on COVID-19, it’s seems that he did not know what’s happening, and they (PhilHealth officials) cannot defend the circular, and the events leading to the issuance of the circular,” Tan told a television interview.
As far as Tan is concerned, Health Undersecretary Leopoldo Vega could do better than Gierran.
“I was thinking, Usec. Vega, having that experience for a very long time,” she said, underscoring Vega’s experience as a medical center chief.
Earlier, Go reached out to Gierran, Executive Secretary Salvador Medialdea and Secretary Carlito Galvez, Jr. to help resolve some issues raised by hospital associations and protect the stability of the health system.
“Let us give them an extension because we are in a different situation now. We are facing a pandemic and we need to help each other to cope up with this and protect the lives of our people," he said.
