Metro Manila (CNN Philippines, October 25) – The Philippine Health Insurance Corp. has partly restored the accreditation of two Mindanao hospitals, which have cases of suspected fraud.
PhilHealth President and Chief Executive Officer Ricardo Morales said in a media briefing on Friday: “We restored their accreditation. They can continue receiving PhilHealth members, but the procedure … involved in the … suspected fraud, yun ang [that one is] suspended.”
Morales said that the reinstatement of the revoked accreditation takes effect on Friday.
The two hospitals based in SOCCSKSARGEN were stripped of their accreditation due to “upcasing,” which is the process of declaring that a patient has a more serious illness than the actual affliction to get higher reimbursements from the state health insurer.
The decision comes after the Private Hospitals Association of the Philippines (PHAPi) sent an open letter to Morales saying that these medical facilities were not given the opportunity to be heard in a formal hearing.
Morales defended PhilHealth, saying that the insurer is just “taking extra care” following the WellMed controversy. WellMed supposedly filed for reimbursements for all allowable kidney dialysis sessions for its clients even if the patients have not availed of the treatments or have died without availing of such medical care.
In the same letter, PHAPi said might cut ties with PhilHealth for failing to pay the claims of some of its members.
Hospitals’ threat to cut ties with PhilHealth ‘a cheap stunt’
Still reacting to PHAPi’s letter to him on October 15, Morales also called the threat of 600 private hospitals to cut ties with the government corporation a “cheap stunt.”
He also insisted that the open letter, containing a threat that some 600 private hospitals would opt not to renew their PhilHealth accreditation due to unpaid claims worth almost P2.5 billion, is only a “blackmail.”
“Di naman totoo na magpu-pull out ang 600 hospitals,” he said.
[Translation: It is not true that 600 hospitals will pull out their accreditation.]
Morales earlier warned that some of these member hospitals cannot afford to cut ties with the state health insurer because they are “sustained by PhilHealth reimbursements.”
But Morales said that he had a meeting with PHAPi and reached an agreement with the group.
He said that PHAPi will let PhilHealth work directly with the private hospitals from which it owes money. Reconciling its unpaid claims to hospitals will give both parties a chance to explain their respective sides, he added.
Morales also issued an appeal to the affected hospitals to reach out to PhilHealth directly instead of resorting to “threat and intimidation.”
He earlier admitted that PhilHealth has an outstanding balance with private hospitals, but gave no exact figures.
He explained that PhilHealth has debts because of its backlog.
