HMO denies fraud charges by PSSLAI

MANILA, Philippines - A health maintenance organization (HMO) denied fraud allegations by a loan group set up by police officers, firefighters and their families after it ceased providing health care services to them.

The Public Safety Savings and Loans Association, Inc. (PSSLAI) earlier filed complaints against Medocare Health Systems, Inc. with the Quezon City Regional Trial Court. It also asked the Department of Health and the Securities and Exchange Commission to suspend Medocare’s accreditation and license to operate.

Medocare, the HMO contracted by the PSSLAI, said in its statement there was no misrepresentation, fraud and betrayal of public trust on its part.

Medocare said the PSSLAI board members and officers were the ones guilty of the charges.

Medocare said its agreement with PSSLAI states that health coverage for PSSLAI members was valid from Aug. 1, 2014 to July 31 and the coverage was terminated at midnight of July 31.

Applications for health care coverage beyond Aug. 1, 2014 by PSSLAI members would not be honored as it was no longer covered by the agreement, the HMO said.

Medocare stressed the agreement for health care coverage was made between the HMO and PSSLAI boards, not between Medocare and individual PSSLAI members.

Medocare added this happened because PSSLAI refused to renew its health care coverage agreement with Medocare for 2015 to 2016.

Medocare offered a higher rate and a monthly-basis payment instead of annual payments, which was done for three years.

The higher rate was prompted by the low enrolment recorded by PSSLAI. For the health care coverage program for 2014-2015, PSSLAI registered only over 1,000 members, lower compared to over 3,000 each for 2012 to 2013 and 2013 to 2014.

Medocare also claimed it informed affected PSSLAI members of the termination and that it was willing to refund their contributions, equivalent to “net of the 12 percent commission and P800 per member markup given to PSSLAI.”