PhilHealth to fine erring hospitals

The Philippine Health Insurance Corporation (PhilHealth) announced that it will impose fines against erring hospitals instead of outright suspension or revocation of their accreditation.

The state agency said that it has the authority to impose maximum fines on hospitals guilty of violating PhilHealth-related regulations, rules and guidelines as stated in Board Resolution No. 2334, series of 2017, and its implementing guidelines as contained in Corporate Order 2018-0039.

The agency said that with the said policy, it will keep its commitment to curb fraud and protect its fund from abuse and pilferage without interrupting access to health care services.

“We recognize that suspending or revoking a hospital’s accreditation will result to members not being able to avail of their benefits when they or their dependents are admitted in these facilities,” said PhilHealth acting president Dr. Roy Ferrer in a statement.

PhilHealth stated that 298 cases from 71 hospitals nationwide are undergoing arbitration due to various violations such as fraudulent acts and breach of warranties of accreditation/ performance commitment, filing of multiple claims, misrepresentation by furnishing false or incorrect information, and claiming for non-admitted patients, among others.”

PhilHealth, however, clarified that the policy of imposing maximum fines does not apply to cases against health care professionals, cataract cases through recruitment schemes, cases that are already on appeal with the courts, and to recidivists or those who have been repeatedly sanctioned for the same offense.

Ferrer said that from 2010 up to the present, PhilHealth suspended at least 31 hospitals and revoked the accreditation of two healthcare facilities for certain violations, such as extending period of confinement, misrepresentation, and claims made for non-admitted patients.