DOCTORS said health insurance fraud is not as prevalent as the Philippine Health Insurance Corp. (Philhealth) suggests, after the latter issued a circular outlining the grounds for denying or withdrawing PhilHealth accreditation.
In a position paper published Thursday in the Philippine Daily Inquirer, doctors’ associations said that PhilHealth Circular 2020-0003 which sets guidelines for the denial or withdrawal of accreditation is “insulting the health profession.”
“The circular’s focus on preemptive penalties for noncompliance gives the unintended impression that violations are more often the rule rather than the exception in our profession which is far from the truth,” the associations said.
The paper was signed by the Philippine College of Physicians; Philippine College of Radiology; Philippine College of Surgeons; Philippine Obstetrical and Gynecological Society; Philippine Pediatrics Society; Philippine Society of Pathologists; Philippine Society of Anesthesiologists; Philippine College of Chest Physicians; Philippine College of Geriatric Medicine; Philippine College of Hematology and Transfusion Medicine; Philippine Heart Association; Philippine Rheumatology Association; Philippine Society of Allergy, Asthma and Immunology, Inc.; Philippine Society of Endocrinology, Diabetes and Metabolism; Philippine Society of Gastroenterology; Philippine Society of Hematology and Blood Transfusion; Philippine Society of Medical Oncology; Philippine Society for Microbiology and Infectious Diseases; Philippine Society for Nephrology; Diabetes Philippines; Philippine Dermatological Society Philippine Neurological Association; and the Philippine Society for Nuclear Medicine.
Based on the Circular, PhilHealth claims the authority to control the accreditation of health care providers participating in the National Health Insurance Program (NHIP).
The grounds for withdrawal or denial of accreditation include any of the following: noncompliance with any accreditation requirement; pending cases with the PhilHealth’s Prosecution Department; committing fraud or any crime related to the NHIP; or any other validated monitoring findings. — Gillian M. Cortez
