Eye clinics hit PhilHealth for suspending claim payments

MANILA, Philippines - Eye clinics have decried the move of the Philippine Health Insurance Corp. (PhilHealth) to abruptly suspend payments for reimbursement claims due to alleged anomalies in the system.

Raymond Evangelista, chief executive officer of the Quezon City Eye Center (QCEC), said yesterday the decision of PhilHealth is “arbitrary, derogatory and wanting in legal basis.”

“Up to the present, PhilHealth officials have not yet presented a single evidence or testimony to support the charges they made against QCEC. It was extremely irresponsible for them to drag the good name of our clinic, the reputation of which took years of hard work to build, into this controversy without caution and careful consideration as to its consequence,” he added.

He stressed that the eye center is open to any investigation but deplored the move of PhilHealth.

Last May, PhilHealth ordered the suspension of payments of claims filed by at least two eye centers, Pacific Eye Center and QCEC, alleging a drastic increase in claims that it said was indicative of fraudulent practices.

But Evangelista said PhilHealth blatantly defied its very own circular when it implemented the suspension against QCEC, which, he said, was a long-time government-accredited health care provider.

He cited PhilHealth Circular No. 54 issued in 2012 which states that any institutional health care provider (IHCP) found in violation of agency circulars shall receive feedback from PhilHealth “requesting for prompt action to implement corrective measures addressing said violations...”

It directs the IHCP to “submit a plan of action to correct the same within 15 days from receipt of feedback from PhilHealth.”

Abakada-Guro party-list Rep. Jonathan de la Cruz also hit PhilHealth for its “ill-advised” move, saying many indigent patients will be deprived of treatment.