On the alleged unpaid claims to PHAPI hospitals

PHILHEALTH categorically denies as unfounded, malicious and irresponsible the statement made by Dr. Rustico Jimenez that 300 or so private hospitals are facing closure due to delayed payments by Philhealth. From Jan 1 to May 29, 2020, Philhealth has disbursed a total of Php 52.53 billion in claims payment and Interim Reimbursement Mechanism (IRM). Payment of claims amounted to Php 38.6 B which includes Php 4.74 billion paid through its accelerated Return to Hospital (RTH) initiative. Php13.93 billion was released under the Interim reimbursement mechanism. Of claims paid, Php21.8 billion ((56.5%) were paid to private facilities.

Claims reimbursements were processed at an average turnaround time of 41 days with a denial rate of 2%. The increase in turn around time is due to adjustments for the Covid19 pandemic.

Philhealth has earlier published a statement explaining the purpose and reconfiguration of the IRM program in order to husband its funds for the long term while concentrating on areas with high Covid19 incidence. Philhealth has never issued a “promise” of IRM release to all hospitals. This was a misinterpretation of Dr. Jimenez’.

Philhealth does not recognize Dr. Jimenez as a legitimate representative of any hospital association because of his historical pattern of wild and unfounded accusations. Earlier this year, Dr. Jimenez threatened non-renewal of accreditation by his hospital members for alleged late Philhealth payments. When directly queried, hospitals denied any such intention and proceeded with their renewals including Dr. Jimenez’ own Medical Center Paranaque which has received an IRM of P6 million and P28 million in benefit payments in 2019. It seems that Dr. Jimenez does not speak for these hospitals he claims as members of PHAPI.

In a meeting in Malacanang last year Philhealth President Ricardo Morales and Dr. Jimenez agreed to resolve the alleged late payment issue by making each hospital meet directly with their Philhealth counterpart staff at their respective levels to reconcile their books of accounts. Those hospitals which complied have reported satisfactory results. Unfortunately, some hospitals which ignore Philhealth claims procedures and fail to comply with data quality standards continue to experience denial or return of claims causing avoidable delays.

While Dr. Jimenez is accusing Philhealth of delayed payments, the Corporation is also facing accusations from other quarters of doing exactly the opposite – illegal overpayments. Philhealth is trying to balance on a razor’s edge to settle each claim quickly in the most fair and equitable manner possible. It is unfortunate that Dr Jimenez chooses a publicity stunt instead of the mutually agreed upon procedure of account reconciliation by both parties. Philhealth will not be threatened by what amounts to blackmail into paying out public funds without due diligence.

Philhealth’s Legal Department is now exploring filing libel charges against Dr. Jimenez at the same time its regional staff continues to work directly with all its hospital partners to resolve the issue of account reconciliation.

Executing the Universal Health Care Law, even without the Covid19 pandemic was already a daunting task. Under these more difficult conditions the Corporation keeps it sight on its mission - to provide adequate, available and affordable health care to all Filipinos when they need it. It enjoins all Filipinos to work with it in this most noble of all undertakings.

Mabuhay Ang Universal Health Care! Mabuhay Ang Pilipinas!