Philhealth, private hospitals butt heads; accuse each other of lying

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State-owned agency Philippine Health Insurance Corp. (PhilHealth) on Monday went head-to-head with private hospitals, as each accused the other of lying about an alleged mounting backlog of reimbursement claims.

PhilHealth president Alexander Padilla said at a press conference that contrary to the claims of Private Hospitals Association of the Philippines (PHAP) president Rustico Jimenez, the state agency had no reimbursements backlog.

Padilla, however, acknowledged that agency was still processing P19.2 million in claims.

“There is no backlog. There is no truth to the allegations of Dr. Jimenez,” Padilla said.

He added that of the 10 hospitals on the list provided by Jimenez, PhilHealth has already paid all outstanding good claims for seven. Furthermore, that the agency is currently processing the claims of the remaining three hospitals in the amounts of P9 million for Calamba Doctors Hospital, P7 million for the Gingoog Sanitarium Misamis Oriental, and P3.2 million for the Virgen Milagrosa Hospital in San Carlos.

But Jimenez, president of the 600-member Private Hospitals Association of the Philippines Inc., brushed aside Padilla’s denial as “foolishness.”

“They’re all lying, and they were just talking about the same thing…. He has only been talking about these 10 hospitals. What about the other hospitals to which Philhealth has incurred huge debts?” Jimenez said.

“Now they’re accusing me of telling lies. They were the ones lying. When I asked them about their fat bonuses last December, they denied it, but it turned out that they gave themselves fat bonuses of over P1 billion. So, who’s lying now?’ Jimenez said.

According to Jimenez, PHAP members were intimidated that PhilHealth would withhold their collectibles, should they complain.

By way of further explanation, Jimenez added that PhilHealth was religious in reimbursing big hospitals like Makati Medical Center, Medical City, Capitol Medical Center, and St. Luke’s, but owed smaller hospitals a mounting backlog.

“They are afraid if these big hospitals will complain so PhilHealth has not been remiss in their reimbursements,” Jimenez said.

Jimenez also questioned how PhilHealth could afford to give its board members fat bonuses whereas it could not pay its debts on time, but Padilla insisted that the board bonuses were aboveboard.

“PhilHealth is operating within the budget set by law and our administrative cost is no way connected to our payment of reimbursements. If you also consider the alleged backlog with the total reserves of PhilHealth of around P117 billion, that (alleged backlog) is less than one half of 1 percent of our total reserves,” Padilla said.

He likewise warned private hospitals who are planning not to honor PhilHealth benefits that they could be blacklisted.

“There are several possible sanctions. We can even suspend or revoke their accreditation, which means they will not be getting any reimbursements from PhilHealth. We can create a blacklist of those hospitals… so that in turn we will tell the public not to patronize these hospitals,” he said.

For his part, Jimenez said that PHAP memberswould make good their threat of no longer honoring PhilHealth cards if the state agency does nothing about its unpaid debts. He added that “hospitals are restless now because they have not been paid for at least six months. They also have to pay their bills, like for the water and electricity, and they are running out of funds.”

Padilla pointed out that membership in PhilHealth is voluntary, and a hospital cannot be forced to get accreditation.