PhilHealth imposes fines on 3 erring hospitals

The board of directors of the Philippine Health Insurance Corp. (PhilHealth) has fined at least three accredited hospitals for violating salient provisions of the National Health Insurance Act of 1995.

In a statement, PhilHealth said the Brokenshire Integrated Health Ministries Inc. (BIHMI) in Madapo Hills, Davao City and the Western Mindanao Medical Center (WMMC) in Zamboanga City were fined for multiple claims and for requiring patients to pay fees for claims processing, respectively.

The BIHMI filed a claim on Dec. 1, 1999 only to file another claim for the same patient and confinement a week later.

The hospital, PhilHealth said, admitted that it failed to notice that a previous claim for the same patient and period of confinement had already been filed.

But the PhilHealth board said BIHMI’s admission of guilt is not enough ground for the hospital to be absolved from its liability.

The WMMC, on the other hand, was found to have required a member to pay P100 as claims processing fee.

Based on the member’s complaint, a spot inspection was made and another member affirmed the collection of the fee.

While the hospital claimed that the fee was for messengerial service, the entries in the official receipts issued by the hospital clearly stated that the P100 was for claims processing.

The BIHMI was fined P20,000, and the WMMC, P10,000, and was directed to refund the processing fee collected from the member-patient.

Meanwhile, PhilHealth found the West Visayas State University Medical Center (WVSUMC) in Iloilo City to have violated Section 149, Rule XXVIII of the revised implementing rules and regulations of the NHI Act of 1995 by extending the period of confinement of a patient for the purpose of claiming support from the National Health Insurance Program (NHIP).

The WVSUMC admitted a patient on July 18, 2000 but this claim overlapped with the patient’s confinement in another hospital within the region, prompting the PhilHealth regional office in Iloilo City to deny payment for the claim. The hospital was fined P25,000.

PhilHealth is vested with quasi-judicial powers that enable it to act judiciously and swiftly on cases involving its partners in implementing the NHIP.