PhilHealth responds

This refers to the article “Gordon: PhilHealth owed PRC P320 million for COVID-19 tests” by Mark Ernest Villeza published last June 6 in The STAR.

PhilHealth acknowledges that it has an unsettled balance with the PRC for the RT-PCR claims of approximately P320 million, but this is due to various deficiencies in the documents submitted to us.

Per our records, we have been able to pay the PRC a total of P8,278,218,536.00 for 2,476,566 tests since 2020.

PhilHealth halted the processing of some 66,024 PRC claims in the amount of P221,561,144.00 due to non-submission of duly accomplished Case Investigation Form (CIF) and inconsistencies and deficiencies in the validated line list or summary of test results, which are not in conformance with the provisions under the Memorandum of Agreement between PhilHealth and PRC. Another set of claims was on hold in the amount of P99,010,800.00, with no submitted CIFs. The temporary cessation of processing is in abeyance to Commission on Audit (COA) Observation Memos 21-013 (20) HO, 22-001 (21) HO, and 2023-031 (20-22) HO, dated June 30, 2021, May 18, 2022, and June 26, 2023, respectively.

PhilHealth remains committed to the PRC as our partner in the country’s fight against COVID-19. However, as stewards of the National Health Insurance Fund and as a government institution, it is bound to follow state auditing rules and regulations. The PhilHealth Management is currently awaiting the results of the COA Special Audit on the appropriateness to pay these claims that have been submitted with deficiencies.

PhilHealth is also in constant communication with the PRC regarding this matter.

Rest assured that we will update you on the matter as soon as this is resolved. – Rey T. Balena, acting vice president, corporate affairs group, PhilHealth