PhilHealth owes billions to private hospitals - exec

Jamaine Punzalan, ABS-CBN News

Posted at May 08 2018 11:18 AM | Updated as of May 08 2018 09:28 PM

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MANILA (UPDATE) - The Philippine Health Insurance (PhilHealth) owes billions to private hospitals across the country, a leader of the medical community claimed Tuesday as the agency faced investigation for alleged anomalies. 

Dr. Rustico Jimenez, president of the Private Hospital Association of the Philippines (PHAP), said the agency's debt ballooned after it ordered hospitals to apply for reimbursement claims through an online portal.

"Ang sabi nila, 'pag ginamit namin ang e-claims, mas mapapabilis po ang bayad. Ngayon po, ang nangyari lalo pong na-delay ang bayad namin. Hindi po makapasok sa kanilang portal e," he told DZMM. 

(They said if we use e-claims, the reimbursement will be quicker. But the delay in payments worsened instead. We can't even enter their portal.) 
Some hospitals may shut down or refuse non-emergency patients if PhilHealth does not settle its alleged debts soon, Jimenez warned. 

"Kung hindi pa po magbabayad ang PhilHealth by this time, or 2 weeks' time, baka marami nang magsara. Baka mag-ano na po kami, hospital holiday," he said. 

(If PhilHealth does not pay by this time, or in 2 weeks' time, many hospitals may close. We may impose a hospital holiday.) 

"Baka hindi na po namin tanggapin ang patients ng PhilHealth kasi po wala nang ipangtutustos ang ospital... Iyung mga emergency po tatanggapin namin iyun, pero iyung mga elective -- iyung mga hindi naman po kailangan admit-in, check-up lang -- siguro ibibigay na lang po namin iyun sa government hospitals," he added. 

(We may also stop accepting PhilHealth patients because hospitals no longer have funds. We will only accept emergency cases and refer elective ones -- those who won't be admitted and only need check-up -- to government hospitals.) 

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Jimenez's accusations came in the wake of President Rodrigo Duterte's order to investigate the P627,000 in travel expenses allegedly incurred by PhilHealth officer-in-charge Celestina Ma. Jude Dela Serna in 2017 -- the same year that her agency reported an unaudited loss of P9 billion. 

PhilHealth will check if it has failed to process hospital claims within the required 60 days, said the agency's OIC-Vice President and head executive assistant, Dr. Israel Francis Pargas.

"We will do our thing and check kung iyung mga sinabi niya (PHAP's Jimenez)... and we will see what we can do kaagad-agad para d'yan," Pargas said in a separate DZMM interview. 

(We will do our thing and check his statements... and we will see what we can do immediately do about that.)

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Pargas said the agency is working on the technical difficulties of its online portal.

"There are issues right now we are trying to solve but hopefully this particular use of technology would actually result in a more efficient processing not only for PhilHealth but also for the facilities for filing their claims," he said.

Pargas, meanwhile, admitted that the agency currently has a backlog in processing claims by private hospitals.

"Yes, we do owe…In some of our offices, in some of our regions, we have a recorded backlog in the processing of our claims but Dr. Jimenez is saying names of facilities so we would like technically to check those facilities," he said.

Malacañang will also look into the Jimenez's accusation, vowed Presidential Spokesperson Harry Roque. 

"Ito naman po ay iimbestigahan din ng ating Palasyo at kaunting panahon lang po, dahil itong mga balitang ito ay kakaputok lang din po," he also told DZMM. 

(This will also be investigated by our Palace. We only need a little time because this news has just broken.)