‘PhilHealth accumulates P26 billion in debts to hospitals’

MANILA, Philippines — Unless the Philippine Health Insurance Corp. (PhilHealth) pays its debts, hospitals may have to weaken their capacity to deal with the mutating COVID-19 or totally shut down, Sen. Imee Marcos warned yesterday.

“Complaints reaching our office show that at least P26 billion remains unpaid to private hospitals, not to mention its debts to government hospitals amounting to hundreds of million of pesos. Let’s not wait for them to shut down or leave them ill-prepared to deal with the possible spread of the dreaded Delta variant,” Marcos said.

PhilHealth recently announced it had released P6.3 billion through a new system of settling hospital claims known as the Debit Credit Payment Method (DCPM).

However, Marcos said hospitals were being shortchanged because the DCPM did not cover last year’s unpaid hospital claims for COVID-19 treatments.

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

Marcos cited the case of a private hospital that was reimbursed only P430 million out of the P1.2 billion it is claiming, “which is 60 percent of 60 percent – in effect, only 36 percent – of what PhilHealth said it would pay through the DCPM.”

Even government hospitals have not received the full 60-percent reimbursement that PhilHealth should have released, she added.

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

The Lung Center of the Philippines said it has been paid only 40 percent of its receivables from the PhilHealth, with P304 million still to be settled.

The Philippine Heart Center said only 49 percent or P99.47 million has been reimbursed by the state corporation, leaving a balance of over P100 million for claims until March 31.

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

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

“Many Northern Luzon hospitals cannot increase bed capacity because they have not been reimbursed,” Marcos stressed, adding that similar complaints came from hospitals in Western Visayas.

The Private Hospitals Association of the Philippines (PHAPi) confirmed that partial reimbursements to its members via DCPM were concentrated in the National Capital Region Plus bubble.

So far, only about 210 hospitals have agreed to participate in the DCPM, out of the 350 hospitals in the NCR Plus bubble and 1,270 health care facilities all over the country.

The PHAPi, which has 700 members, said that the fear of retaliation is complicating the delay in PhilHealth reimbursements, as many private hospitals hesitate to be more vocal and risk waiting longer to be paid.

“PhilHealth must give a clearer breakdown of reimbursements and explain the discrepancies between what has supposedly been paid and what has actually been received by our hospitals. Let’s not wait for the Delta variant to spread,” Marcos said.