COA doubts PhilHealth's P5 million deferred charges

The Commission on Audit doubted the accuracy of the more than P5 million deferred charges under the debit-credit scheme (DCS) account of the regional office of the Philippine Health Insurance Corporation.

The COA said there were no subsidiary records or schedules to support the charges, making it difficult to determine the unpaid and excess claim payments to hospitals and health care providers (HCPs).

PhilHealth Order 0039-2005 prescribed the DCS of claim payment wherein hospitals and health care providers were initially paid a certain percentage of claims.

At PhilHealth Central Visayas office, claims received as of February 28, 2005 were paid under the DCS scheme, while claims received from March 1, 2005 and those directly filed by the members were excluded from the scheme.

Any overpayment of claims to HCPs under the DCS, according to the order, was to be deducted from the subsequent claims.

The PhilHealth-VII initially paid P153,030,600 for the unpaid claims of 60,178 members of the accredited HCP's from September 1, 2004 to February 28, 2005.

As of December 31, 2005, the balance of deferred charges account was P5,398,905, which according to COA, has no subsidiary records or schedules to support the charges.

The COA recommended that the insurance corporation's management should prepare the needed schedules or subsidiary records to identify the unpaid as well as the excess payment of claims made to the HCPs under the DCS.

But the PhilHealth-VII management said the matter, especially the discrepancies in the balance of accounts of some hospitals, had already been referred to the Management Information System (MIS).

It added that its finance division is still waiting for MIS' reply. - Ferliza C. Contratista/LPM