PhilHealth to suspend erring hospitals, clinics

MANILA, Philippines – The Philippine Health Insurance Corp. (PhilHealth) has issued a circular suspending the accreditation of erring hospitals and clinics facing administrative charges for defrauding the government agency.

In PhilHealth Circular No. 47-2009, PhilHealth president and chief executive officer Dr. Rey Aquino said “despite the institution by Philhealth of appropriate administrative cases against accredited health care providers which are involved in fraudulent practices, some of these providers continue to perpetuate the same practices.”

Among these practices are filing padded claims, claims for non-admitted patients, extending the period of confinement, postdating of claims, misrepresentation by furnishing false or incorrect information, and fabrication or possession of fabricated forms and supporting documents, among others.

Aquino said that because of this, the PhilHealth board found it necessary to “further strengthen the capabilities of PhilHealth to adequately address such fraudulent practices.”

He said “one effective way is to enable PhilHealth... to place errant providers with pending administrative cases under preventive suspension.”

The maximum period for the suspension is 90 days and it shall be automatically lifted once a decision on the case has been rendered and when the suspension is ordered lifted by PhilHealth’s arbitration department.

“A preventive suspension may be imposed only once in a pending administrative case,” the circular stated.

But an official of the Private Hospitals Association of the Philippines (PHAP) criticized the circular, saying the PhilHealth Board did not consult them about it.

“It’s arbitrary. Things like this, we should be consulted... What if we also suspend the services that we are giving our patients?” PHAP president Dr. Rustico Jimenez said in a telephone interview.

Jimenez added the PHAP Board will meet to discuss the measure, which “we think is uncalled for.”