Marcos warns of hospitals’ closure due to PhilHealth’s unpaid claims

Senator Imee Marcos on Wednesday expressed concern over the Philippine Health Insurance Corporation's (PhilHealth) delayed reimbursements to private and public hospitals, saying this could decrease the facilities' capability in caring for COVID-19 patients and eventually lead to closure.

“Complaints reaching our office show that at least Php26 billion remains unpaid to private hospitals alone, while government hospitals are still owed hundreds of millions. Let’s not wait for them to shut down, nor leave them ill-prepared to deal with the possible spread of the dreaded Delta variant,” Marcos said in a statement.

Marcos noted PhilHealth’s recent release of P6.3 billion through the new Debit Credit Payment Method (DCPM) implemented last April.

This, however, will shortchange the hospitals as DCPM doesn’t cover the COVID-19-related expenses from last year, Marcos said.

“Nor was the DCPM fully settling the 60% of hospital claims for reimbursement as directed in the government agency’s own circulars in April and May,” she said.

She cited a case of one private hospital that was only reimbursed P430 million out of the P1.2 in billion PhilHealth claims.

Marcos said the amount is “60% of 60%—in effect, only 36%—of what PhilHealth said it would pay through the DCPM.”

She added that even some government hospitals have not received the full 60-percent reimbursement that PhilHealth should have released.

As of May 31, Marcos said the Philippine General Hospital has only received a reimbursement of 0.0042% or only P2.56 million of its claims for COVID-19 cases totaling P615.7 million.

Meanwhile, the Lung Center of the Philippines said it has only been paid 40% of its receivables from PhilHealth, with P304 million outstanding balance.

She also noted the case of Philippine Heart Center, which only received 49% or P99.47 million, leaving a balance of more than P100 million for claims up to March 31.

The lawmaker said PhilHealth is “fudging its numbers” in the online ledger known as the Reconciliation Summary Module (RSM), which both Philhealth and hospitals have access to.

“Hospitals are complaining that the RSM shows PhilHealth has paid, but the said payments have not yet been deposited in their bank accounts,” Marcos said.

“Many Northern Luzon hospitals cannot increase bed capacity because they have not been reimbursed,” she added.

Marcos urged PhilHealth to give a “clearer” breakdown of reimbursements and justify the discrepancies between the cases that have been paid out and the amount that have been received by the hospitals.

“Let’s not wait for the Delta variant to spread before kicking butt,” Marcos ended.

Senator Grace Poe had previously asked PhilHealth to expedite the release of hospitals’ reimbursement for claims filed since 2020. — BM, GMA News