House panel to mediate between PhilHealth, health sector on claims payment issue

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Metro Manila (CNN Philippines, August 23) — A committee in the House of Representatives is set to meet with the Philippine Health Insurance Corp. and the health sector on Tuesday to tackle the suspension of claims payment to hospitals that are under investigation by the health insurer for suspected fraud.

The House Committee on Health, led by panel chair Quezon City Rep. Helen Tan, said over the weekend that they will hold a "dialogue" between the state health insurer and the Philippine Hospitals Association over the recent issuance of Circular 2021-0013 that would impose a Temporary Suspension of Payment of Claims (TSPC) that the insurance firm suspects of fraud, unethical practices, and/or abuse of authority.

“We want to hold a dialogue between the 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 in a statement on Sunday.

Speaking to CNN Philippines' The Source on Monday, Private Hospitals Association of the Philippines president Jose De Grano expressed hope that they would also be invited by Congress to air their side on the matter.

De Grano stressed that patients may have to bear the brunt of the issued PhilHealth circular by making advance payments which will not be accredited by the state health insurer.

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The PHAPi, PHA, and the Philippine Medical Association said in a statement on Sunday that "the bridge is bound to collapse" and it may be "time to review the engagement with PhilHealth" after the issuance of the circular.

De Grano also raised concern about the absence of the "legal principle of presumption of innocence and our right to due process," with suspected hospitals only bound to be given a non-extendable period of three calendar days to answer the notice of TSPC.

PhilHealth spokesperson Shirley Domingo said, however, that hospitals will also be given at least 10 days "to justify or refute" PhilHealth's findings before an investigation report and a TSPC notice will be issued.

Domingo said that the state insurer has processed about ₱12.9 billion worth of hospital claims at different stages as of June 30. They have also returned about ₱9 billion worth of claims to hospitals due to deficiencies and denied claims amounting to ₱6 billion.

According to the House website, PhilHealth and the Health Department will also discuss the status of the implementation of the Universal Health Care Act at Tuesday's hearing.