THE House committee on public accounts vowed to scrutinize the P14 billion advance payment made by the Philippine Health Insurance Corp. (PhilHealth) to hospitals for coronavirus disease (CoVID-19) cases.
According to committee chairman and Anakalusugan party-list Rep. Mike Defensor, this is questionable since there additional fund releases are suspended.
“We will examine those payments in detail for any sign of fraud and/or overpayment. We have already asked PhilHealth to submit all supporting documents,” Defensor said.
The committee will begin with the P1 billion that PhilHealth has claimed has already been liquidated or supported with documents by hospitals and other healthcare facilities that received advances.
“We hope to get by next week the supporting papers which should indicate the amounts advanced, the recipient-hospitals, amounts liquidated, number and classification of new coronavirus disease cases, number and names of patients, medicines given, and the treatment patients received,” he said.
PhilHealth has reported that it has allocated P30 billion for COVID-19 cases, of which P14 billion has been advanced to health facilities. Of the P14 billion, P1 billion has been liquidated.
Defensor said the reported suspension of additional releases apparently covers the remaining P16 billion.
He warned hospitals to be careful in liquidating and treating as payment the P14 billion PhilHealth has advanced to them.
The state-owned health insurer earlier set “case/package rates” for COVID-19 cases: P43,997 for mild pneumonia, P143,267 for moderate pneumonia, P333,519 for severe pneumonia, and P786,384 for critical pneumonia/coronavirus disease.
Defensor said based on the estimate of the Commission on Audit, there is at least a 20-percent “overpayment” in the case of package rates.
“20 percent of P14 billion is P2.8 billion. That is the potential loss from the amount PhilHealth advanced to hospitals. We will watch out for any sign of overpayment or excess payment or claims in the documents we have asked from Philhealth,” he added.
The solon said the health facilities should not make a reimbursement/payment claim for a “package rate” of almost P44,000 for mild pneumonia if it treated a patient only for cough, colds and fever.