THE Commission on Audit (COA) was pressed Monday to disclose its 2020 Audit Report on the Philippine Health Insurance Corp. (PhilHealth) to give lawmakers “a clear picture” of PhilHealth’s state of finances as Congress deliberates on the 2022 national budget bill.
Senator Grace L. Poe stressed the neeed for full disclosure of PhilHealth’s current financial standing.
“We need to know exactly how much PhilHealth owes hospitals and healthcare workers,” Poe said. “They must be paid soon and government must figure out where to get the funds.”
In a statement, Poe pointed out the COA report will “render a credible audit” of PhilHealth’s financial condition and “see to it that funds are effectively used” for the people’s health-services needs.
Airing concerns that operations of hospitals are at risk, the senator said “we are still in a pandemic and people are still dying,” reminding that “PhilHealth must not hide or sugarcoat its numbers.”
Poe pointed out that the COA’s 2019 Annual Audit Report on PhilHealth showed that benefit claims have totaled P75.57 billion, noting that this was “close to double the P39.79 billion benefit claims reported at the end of 2018.”
She noted that members of the Private Hospitals Association of the Philippines Inc. (PHAPi) are “still awaiting PhilHealth’s action” to pay the Covid-19 claims from 2020, prompting reports that some hospitals are already “contemplating not renewing their accreditation.”
The Senator acknowledged “this will make it difficult for PhilHealth members to reap the full benefits of their membership as they will have to pay for their medical expenses from their own pockets and hope that the state health insurer will reimburse them.”
“PhilHealth cannot resort to delaying and scare tactics to discourage hospitals from pursuing what’s due them,” Poe added noting that after PHAPi reported the problem, some hospitals received summonses from the National Bureau of Investigation concerning their claims.
She noted that reports reaching her office indicated that PhilHealth received 35,147 Covid-19 claims from hospitals in 2020 but only 10,265 of the claims were paid, amounting to P2.5 billion.
Moreover, the Senator added that of the 2,859 claims for critical Covid-19 cases, PhilHealth only paid 642 claims or P505.6 million and refused to pay for 309 cases amounting to P243 million. Poe noted that PhilHealth returned 1,179 claims of hospitals for critical cases costing P927.15 million and 729 claims for critical cases were still under process as of July 31, 2021.
Reports reaching her office also stated that for critical Covid-19 cases, PhilHealth ought to have shouldered P786,384 of a member’s hospitalization.
Noting that the 2019 COA report, likewise, aired concerns on PhilHealth’s actuarial estimates and assumptions, she said it also “sought an improvement in its actuarial valuation process.”
The senator recalled that “before Covid-19, COA already had concerns on PhilHealth’s actuarial valuation process.”
She added that Covid-19 would have “made it more urgent for PhilHealth to get an actuarial study of the fund to come up with a set of recommendations that would make the fund viable and sustainable.”
Poe emphasized that Senators need to examine PhilHealth’s finances and take that into consideration in the discussions for the 2022 government budget.