Many private hospitals might no longer renew their PhilHealth accreditation

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Metro Manila (CNN Philippines, October 21) — Many private hospitals might opt not to renew their accreditation with the Philippine Health Insurance Corporation (PhilHealth), which allows their patients to avail of services which would be paid by the state health insurer.

The Private Hospitals Association of the Philippines (PHAPi) said in an open letter addressed to PhilHealth President Ricardo Morales that most hospitals have yet to receive their reimbursements from PhilHealth and that some hospitals in Mindanao were stripped of accreditation over pending cases.

“Many of our members are alarmed that they may experience the same fate and are now signifying their intention not to renew their accreditation next year,” PHAPi said in the letter dated Tuesday last week and published in a newspaper.

PHAPi said they could not understand why some hospitals in Mindanao got their PhilHealth accreditations revoked when no decision has been reached on the complaints against them over upcasing — the practice of declaring that a patient has a different ailment to get higher reimbursements from the state health insurer.

PHAPi also claimed that these hospitals were not given the opportunity to be heard in a formal hearing.

It added that PhilHealth is sending back to hospitals claims that it found to be deficient due to “non-compliance to standard of care.” It said that when hospitals write back to the state health insurer, PhilHealth either does not respond or would respond late.

PHAPi also aired out its opposition to certain provisions in the approved implementing rules and regulations of the Universal Health Care law.

CNN Philippines has reached out to Morales for comment.

PhilHealth had been in hot water over allegations that it paid for the dialysis treatments of patients who were already dead. This led to charges against PhilHealth officials and owners of WellMed Dialysis Center. President Rodrigo Duterte also asked for the resignations of top officers of the state health insurer.

PhilHealth has also admitted that it has failed to pay ₱14-billion worth of claims as of December 2018 amid the agency losing billions in net operating expenses.