Poe to COA: Release report on PhilHealth’s finances

MANILA, Philippines — The Commission on Audit (COA) should immediately release its 2020 report on Philippine Health Insurance Corp. to give legislators a clear picture of PhilHealth’s finances while discussion on the 2022 national budget is ongoing, Sen. Grace Poe said yesterday.

“We need to know exactly how much PhilHealth owes hospitals and health care workers. They must be paid soon and government must figure out where to get the funds,” Poe said.

“The operations of hospitals are at risk. We are still in a pandemic and people are still dying. PhilHealth must not hide or sugarcoat its numbers,” she added.

In COA’s 2019 annual audit report on PhilHealth, benefit claims have totaled P75.57 billion, close to double the P39.79 billion in benefit claims reported at the end of 2018.

The Private Hospitals Association of the Philippines Inc. (PHAPi) said they are still awaiting PhilHealth’s action to pay the COVID-19 claims from 2020, even as some hospitals said they are thinking of not renewing their accreditation.

Poe said if that happens, PhilHealth members would find it difficult to tap the full benefits of their membership as they will have to pay for their medical expenses from their own pockets and can only hope that the state health insurer will reimburse them.

“PhilHealth cannot resort to delaying and scare tactics to discourage hospitals from pursuing what’s due them,” she said after PHAPi reported that some hospitals have received summons from the National Bureau of Investigation concerning their claims.

PhilHealth received 35,147 COVID-19 claims from hospitals in 2020 but only 10,265 of the claims were paid, amounting to P2.5 billion.

Of the 2,859 claims for critical COVID-19 cases, PhilHealth only paid 642 claims or P505.6 million. It refused to pay for 309 cases amounting to P243 million.

PhilHealth returned 1,179 claims of hospitals for critical cases costing P927.15 million and 729 claims for critical cases were still under process as of July 31, 2021.

For critical COVID-19 cases, PhilHealth ought to have shouldered P786,384 of a member’s hospitalization.