Hospitals fail to give mandatory discounts to seniors worth over ₱500M – COA

Metro Manila (CNN Philippines, August 11) – The Commission on Audit (COA) found that various health care institutions (HCI) failed to give senior citizen patients their mandatory 20% discount on hospital and doctor’s fees.

In its latest report on the Philippine Health Insurance Corp. (PhilHealth), the COA flagged almost 200 thousand claims without senior citizen discounts from seven regional offices, resulting in overpayments of around ₱535 million.

Auditors said PhilHealth should have established a system to ensure that adjudicators validate the proper deductions.

“In the absence of such controls, SCns (senior citizens), member-patients were deprived of the full benefits of the discounts and were compelled to pay outstanding balances out of pocket,” COA pointed out.

The highest numbers of claims without SC discounts were found in Metro Manila, Rizal Province, Central Visayas, and Davao Region.

According to COA, PhilHealth ended up shouldering around ₱113 million in overpayments. Over ₱422 million were covered by other government agencies such as the Department of Social Welfare and Development and the Office of the President.

“PhilHealth and other government agencies offering health insurance and medical assistance incurred unnecessary expenses while HCIs benefited from the overpayments,” COA said.

COA also said the insurance corporation’s top officials said they have directed their regional offices to ensure senior citizens are given discounts in accordance with the law.

State auditors also urged insurance corporations to address inconsistencies in the SC discounts computation by identifying similar issues nationwide and applying appropriate remedies.

Insurance corporations should also work on recovering overpayments of PhilHelath claims to minimize these financial losses, COA added.