By Bianca Angelica D. Añago Reporter 
and Russell Louis C. Ku 

PHILIPPINE HEALTH Insurance Corp. (PhilHealth) President and Chief Executive Officer Dante A. Gierran has pledged to release funds for 60% of the unpaid claims of private hospitals by the end of next week.   

In a House hearing on Thursday, Mr. Gierran said PhilHealth owes private hospitals a total of P21.1 billion as of Aug. 24.  

“P17 billion is already in the pipeline, we’re just waiting for the documentations,” he said.  

Mr. Gierran also clarified that the delay in the release of claims was due to “miscommunication” with the private hospitals, primarily due to problems in their information and communications technology.   

Private hospitals have threatened to cut ties with the state insurer, citing the impact of payment delays to their operations, especially amid the coronavirus pandemic.    

PhilHealth’s Senior Vice President Emily B. Roque also said that “there is a delay in coronavirus disease 2019 (COVID-19) payments because PhilHealth has policies that need to be amended to improve the processing of COVID claims.”  

In a news briefing on Aug. 23, Presidential Spokesperson Herminio L. Roque, Jr. urged PhilHealth to immediately pay private hospitals so as not to further burden the country’s healthcare system.   

This was after PhilHealth announced that it will temporarily suspend the payment of claims to healthcare providers that are “subject of investigations pertaining to fraudulent” claims.   

PhilHealth said that from January to Aug. 2021, there were 5,872 fraudulent claims filed by the corporation’s prosecution department to its adjudication department.  

Health groups, however, said PhilHealth “aims to suspend the payment of hospital claims on the ground of apparent or probable cause, or on a mere suspicion.”      

Anti-Red Tape Authority Secretary Director General Jeremiah B. Belgica has recommended that PhilHealth release the payment for claims “within three days, evaluate diagnosis within 20 days, then release full payment afterwards.”  

He added that PhilHealth must follow their mandate that claims should be released within a maximum of 60 days.  

Meanwhile, a House representative who authored a bill last year that would open Philhealth to the private sector said on Thursday that privatization will help the embattled state insurer hire manpower that can investigate possible fraudulent claims.    

“It doesn’t mean that privatizing Philhealth is that we will sell PhilHealth. What I’m saying is let’s outsource certain functions from the private sectors,” Marikina Rep. Stella Luz A. Quimbo said in a One News interview.  

House Bill 7429, also known as the Social Health Insurance Crisis Act of 2020, would grant power to the President to privatize any or all segments of PhilHealth and can abolish or create offices, transfer functions, and do drastic cost-cutting to carry out the move.  

It would introduce the creation of an Executive-Legislative Commission to craft policy framework and carry out necessary steps to reorganize the state insurer, including the designation of a transition team that will assume management until its reorganization is completed within two years. 

Ms. Quimbo said the circular on withholding payments is not the best way to prevent fraud in PhilHealth, and suggested that the state insurer should instead increase legal capacity and use information technology to detect malpractices.