By J. Jala | 10:47 AM August 22, 2021
The Philippine Health Insurance Corp. (PhilHealth) is suspending payments to hospitals and medical professionals with reimbursement claims under investigation for fraud – a move that may prompt private hospital organizations to “disengage” from the state-run health insurer.
Under PhilHealtlh Circular No. 2021-0013 issued yesterday, a temporary suspension of payment of claims is in effect for 120 days. TSPC is a “conditional stoppage of payment for claims undergoing investigation.”
PhilHealth president and CEO Dante Gierran said the measure has been employed “in order to assure rational use of funds by detecting potential fraud or reimbursement abuse through dubious claims.”
“It is not a penalty, but a preventive measure to avoid the loss or wastage of funds due to fraudulent acts, unethical acts and abuse of authority,” the PhilHealth said.
It clarified that it shall continue to receive and process all claims from health care professionals (HCPs) with TSPC Order. However, payment shall be put on hold pending investigation or resolution of cases.
The TSPC may be lifted upon the expiration of 120 days, unless otherwise extended to warrant further investigation of not more than 90 days or upon the resolution of the case.
All health care providers can rest assured that this policy will be enforced with respect to due process and existing rules and regulations. Likewise, this policy will affect only providers engaged in fraudulent acts against the funds entrusted to the Corporation by its members.
PhilHealth assures its members and accredited providers that all good claims shall not be affected by this policy.