9 CV hospitals charged for false claims: Philhealth

NINE hospitals were administratively charged by the Philippine Health Insurance Corp. (Philhealth) 7 for misrepresentation by filing false and incorrect information to claim a refund.

If found guilty, they violated the Implementing Rules and Regulations of Republic Act 7875, or the National Health Insurance Act of 1995.

Ligaya Barcenas, Philhealth 7 legal division chief, said that under the present policy, the penalty for erring doctors and hospitals is P50,000 per violation.

Last year, the Philhealth Board had removed the penalty of suspension, converting it to a fine of P50,000 per violation.

Before, those found guilty faced either a suspension and/or a penalty.

However, a source said the suspension of accreditation with Philhealth should have been retained and the penalty raised to P5 million for erring hospitals and P2 million for erring doctors as a deterrent to fraudulent claims.

The source said the P50,000 fine can easily be recovered by an erring hospital or doctor from only one patient.

Meanwhile, Barcenas said the Philhealth accreditation of Englewood Hospital in Tagbilaran City, Bohol was revoked after three convictions last April.

Prior to that, the hospital’s accreditation was suspended and it was made to pay a fine of P10,000 after Englewood filed claims for two non-admitted patients and it extended a patient’s period of confinement.

Philhealth 7 also suspended the accreditation of a birthing home in Barangay Lahug, Cebu City and fined it P10,000.

Barcenas said the home made it appear that a woman who gave birth in its Lapu-Lapu City branch, which is not accredited by Philhealth, gave birth in its Lahug branch, which is.

Barcenas said it was a case of misrepresentation.

She said they sent “patient benefit notices” to patients so they’d know how much they availed themselves of Philhealth during hospitalization.

If patients find the refund exhorbitant, they may act as whistleblowers, she said.

Barcenas said the top five causes of confinement in Central Visayas in 2018 were pneumonia (moderate risk), hemodialysis, routine obstetric care (including delivery and newborn care), cesarean section and septicaemia.