MANILA — The Commission on Audit (COA) has expressed concern for the Philippine Children’s Medical Center (PCMC) after it failed to claim P200.277 million worth of reimbursements from the Philippine Health Insurance Corporation (PhilHealth) over COVID-19 tests for migrant workers.
The unclaimed reimbursments were for RT-PCR tests given to overseas Filipino workers (OFWs) between 2021 and 2022.
In its 2022 annual report on the PCMC, COA noted the lack of supporting documents from the Philippine Coast Guard, which were required by PhilHealth for the filing of claims on benefit packages for the test.
“The non-reimbursement by PhilHealth of said claims may result in a significant loss on PCMC for the operational expenses incurred in the conduct of RT-PCR testing,” the audit report said.
State auditors said a total of 101,333 specimens from OFWs were collected by the PCG and were tested by PCMC’s COVID-19 laboratory amounting to P328.544 million.
Of the amount, P128.268 million were transmitted to Philhealth, but only P81.72 were actually paid.
Inquiries made by the auditors revealed that among the reasons for not filing the claims with PhilHealth were unreadable files and claim forms from the PCG, system glitches resulting from files or claim forms that were not extracted due to a high volume of data entry, and claims with no PhilHealth Identification Number.
The audit team recommended that the PCMC management file a motion for reconsideration with PhilHealth and exert its utmost effort to collect the P200.277 million from PhilHealth.
But the PCMC told COA that they had exhausted efforts to communicate with their partners, such as the Department of Health (DOH), the Overseas Workers Welfare Administration (OWWA), the PCG, and PhilHealth.
The PCMC has also requested a Board of Trustees resolution pertaining to their reimbursement claims to ease the requirements due to extraordinary times and in response to the government’s bid to contain the pandemic.
“This will serve as the supporting document on appeal to PhilHealth to consider the claims and collect the rendered services,” the audit report noted.
The audit team also told the PCMC that it appreciated the efforts to submit the claims to PhilHealth but full compliance with the audit recommendation.
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