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PhilHealth, hospital groups to face House panel over new circular on claims payment

By Lance Arevada

PHOTO: PH Lifestyle

The House Committee on Health is set to hold a dialogue between hospital groups and the Philippine Health Insurance Corp. (PhilHealth) on Tuesday to discuss the updated PhilHealth circular on the temporary suspension of claims payments that has gained criticism from various medical associations.

Quezon Rep. Angelina Tan, chair of the Health committee, said on Sunday that the panel is set to meet members of the hospital associations and officials of the state-run insurer to rebuild the trust and partnership between the two sectors.

“We want to hold a dialogue between PhilHealth and the hospitals. We do not want the bridge to collapse. We want to rebuild whatever trust and partnership that are left between the state health insurer and our healthcare institutions or providers,” Tan said.

This comes after PhilHealth issued its Circular No. 2021-0013 on Friday that updates its guidelines in temporarily suspending the payment of claims of hospitals and healthcare providers that are subject to investigation of fraudulent and/or unethical acts and abuse of authority for three to seven months.

“The Circular was issued in the spirit of proper fund management and fraud control. . . . All health care providers can rest assured that this policy will be enforced with respect to due process and existing rules and regulations,” the insurer said in a statement.

PhilHealth also clarified that the policy on temporary suspension has been in place since 2016 through PhilHealth Circular 2016-026, and that the additional guidelines in the 2021 circular was meant “to allay fears of alleged arbitrary investigations among our providers.”



“Likewise, this policy will affect only providers engaged in fraudulent acts against the funds entrusted to the Corporation by its members. PhilHealth assures its members and accredited providers that all good claims shall not be affected by this policy,” they added.


‘Bridge bound to collapse’

In response to the issued circular, the Philippine Hospital Association, the Philippine Medical Association, and Private Hospitals Association said in a joint statement on Saturday that the bridge between the healthcare providers and PhilHealth is “bound to collapse” which merits a review on their ties with the state-run insurer.

“The bridge between the health care providers and PhilHealth now has serious cracks caused by a feeling of mistrust by PhilHealth against health care providers. The bridge is bound to collapse, maybe it is time to review the engagement with PhilHealth and level the playing field,” they said.

The groups described the latest order issued by PhilHealth as a “baseless” circular and “another ploy to deny or delay their payment of claims.”

“Health Care Providers have come this far, its members for a long time have listened, tried to understand, pleaded and even worked together with PhilHealth. But PhilHealth is just too far at the other end of the bridge to hear the pleas of Health Care Providers,” they added.

While the issued circular seeks to prevent fraud, PhilHealth has been rocked with allegations of massive corruption in 2020 with ₱15-billion worth of funds being stolen that resulted in a mass resignation of its officials including its former President and CEO Ricardo Morales.