PhilHealth vows to pay ₱27-B hospital debt in 90 days

Metro Manila (CNN Philippines, September 7) — The government-run Philippine Health Insurance Corporation (PhilHealth) on Wednesday vowed to settle the majority of unpaid hospital claims amounting to ₱27 billion in 90 days.

During the House appropriations panel's hearing on the Department of Health's proposed 2024 budget, PhilHealth President and Chief Executive Officer Emmanuel Ledesma said they are now in the process of reconciling records with private hospitals.

"I'm confident that within 90 days from today, bulk or majority, if not all, of the ₱27 billion will be paid off. I hope that will make hospitals and doctors happy," he said.

The same agency also promised to pay ₱25.45 billion worth of claims from private hospitals in six months last year.

Then PhilHealth president Dante Gierran said they are having difficulty processing the private hospitals' claims due to lack of manpower and problems in the agency's IT system.

READ: PhilHealth vows to pay over ₱25B hospitals' claims in 6 months

Anakalusugan Party-list Rep. Ray Reyes also criticized huge salary increases of top PhilHealth officials that nearly tripled starting 2022.

"You guys had the guts during the middle of the pandemic to come out with an executive order to triple your salaries. In anticipation of what?" he asked.

According to the Commission on Audit, PhilHealth executives got a total of ₱72 million pesos in salaries and benefits last year compared to ₱26 million in 2021.

But PhilHealth Senior Vice President Israel Francis Pargas said the order came from Malacañang as part of standardizing salaries of government-owned and controlled corporations.

The Department of Health, under which PhilHealth is attached, is eyeing ₱311 billion for next year, ₱11 billion less than its current allocation.

Philhealth denied, returned hospitals’ claims in 2022

Meanwhile, the Commission on Audit (COA) found in its 2022 audit of the Department of Health that PhilHealth last year denied hospital reimbursement claims amounting to ₱590 million.

COA determined that the claims which PhilHealth denied resulted in loss of income for healthcare institutions (HCIs) which could have been used to augment their budgets or to repair existing hospital facilities.

PhilHealth also classified ₱2.23 billion worth of claims as Return to Hospital (RTH). These were then returned to HCIs, urging them to comply with certain requirements.

RTH claims may be revised by HCIs and subsequently reversed by PhilHealth into good claims, but non-compliance could lead to a claim’s denial.

Because PhilHealth sent these claims back, COA said that made HCIs vulnerable to loss of income.

As a result, state auditors recommended affected hospitals to review denied claims in order to possibly refile or appeal these.

COA said the most common causes for denied or RTH claims last year were “over-utilization of services; unnecessary diagnostic and therapeutic procedures and interventions; irrational medication and prescriptions; fraudulent, false or incorrect information as determined by the appropriate office; gross, unjustified deviations from currently accepted standards of practice and/or treatment protocols; and inappropriate referral practices.”

Other circumstances which led to denied or RTH claims include “the use of fake, adulterated or misbranded pharmaceuticals, or unregistered drugs; use of drugs other than those recognized in the latest Philippine National Formulary and those for which exemptions were granted by the Board; and failure to comply without justifiable cause with the pertinent provisions of the any issuances of the PhilHealth.”

CNN Philippines' correspondent Xianne Arcangel contributed to this report.