Hospital groups: Ties with PhilHealth 'bound to collapse'

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Hospital and medical groups warned their relationship with the Philippine Health Insurance Corporation (PhilHealth) is on the verge of collapse and may need a review, after the state insurer suspended the payment of claims that are under suspicion of fraud, among other anomalies. (FILE PHOTO)

Metro Manila (CNN Philippines, August 21) — Hospital and medical groups warned their relationship with the Philippine Health Insurance Corporation (PhilHealth) is on the verge of collapse and may need a review, after the state insurer suspended the payment of claims that are under suspicion of fraud, among other anomalies.

In a joint statement, the Private Hospitals Association of the Philippines, the Philippine Medical Association, and the Philippine Hospital Association said the bridge between healthcare providers and PhilHealth now has "serious cracks."

"The bridge is bound to collapse," the groups said. "Maybe it is time to review the engagement with PhilHealth and level the playing field."

On Friday, PhilHealth published its Circular 2021-0013, which set guidelines on the issuance of Temporary Suspension of Payment Claims or TSPC against healthcare providers and claims under probe for fraud, unethical acts, and abuse of authority.

The TSPC shall not exceed 120 calendar days, but it may extend for another 90 days if the case warrants further investigation.

The groups surmised that this was a ploy to deny or delay payment of their remaining claims, which the Philippine Hospital Association revealed only days ago, was worth over ₱86 billion.

The healthcare providers, however, assured the public that its members will continue to serve PhilHealth-covered patients while their contracts with PhilHealth are still in effect until December.

In a statement, PhilHealth explained the policy has been in place since 2016 and the latest circular only added provisions that would "ensure that due process is observed" in the issuance of the TSPC.

It assured providers that "good claims" will be untouched.