PhilHealth accreditation stays, hospitals fined

MANILA, Philippines — The Philippine Health Insurance Corp. (PhilHealth) is imposing fines on erring hospitals instead of outright suspension or revocation of their accreditation, to ensure their continued services for its members and dependents.

PhilHealth noted that based on Board Resolution No. 2334, series of 2017 and its implementing guidelines contained in Corporate Order 2018-0039, it can impose maximum fines on hospitals liable for offenses in administrative cases with PhilHealth.

Currently, there are 71 hospitals nationwide with a combined total of 298 cases that are in arbitration at PhilHealth due to various violations, such as fraudulent acts and breach of warranties of accreditation/performance commitment, filing of multiple claims, misrepresentation by furnishing false or incorrect information and claiming for non-admitted patients.

The imposition of fines is necessary in keeping with PhilHealth’s commitment to curb fraud and protect its funds from abuse and pilferage without interrupting access to health care services, said Roy Ferrer, PhilHealth acting president and chief executive. 

“We recognize that suspending or revoking a hospital’s accreditation will result to members not being able to avail of their benefits when they or their dependents are admitted in these facilities,” Ferrer added.

The report came out after Bacolod Our Lady of Mercy Specialty Hospital shut down last July after PhilHealth cancelled its accreditation due to alleged fraudulent activities.

Ferrer, however, clarified that PhilHealth’s policy of meting maximum fines against the hospitals does not apply to cases against health care professionals as well as those that are already on appeal with the courts and to recidivists or those which have been repeatedly sanctioned for the same offense.   

“We are not prevented from suspending or revoking hospital accreditation if truly warranted by circumstances,” he warned.

From 2010, PhilHealth had suspended at least 31 hospitals and revoked the accreditation of another two facilities for violations ranging from extending period of confinement, misrepresentation and claiming for non-admitted patients.

Records showed that from 2015 to last June, the agency had detected 2,000 claims that are tainted with fraud amounting to P17.8 million.

For cataract cases due to recruitment schemes, five facilities and 11 health care professionals, with a total of 3,673 cases, are now up for decision.

PhilHealth reported that it recently won cases in the Supreme Court and in the Court of Appeals on these cataract cases, upholding the agency’s actions against erring health care providers.

“This should serve as a warning to those who are still into active recruitment of unsuspecting cataract

patients who are operated on even in very poor conditions in order to sap unwarranted payments from the National Health Insurance Fund,” Ferrer said.