THE Philippine Health Insurance Corp. (PhilHealth) on Saturday has clarified that the new circular suspending claims payment for hospitals and healthcare providers undergoing a probe against fraud has already been existing since 2016.
The state insurer explained that the tightened policy issued as PhilHealth Circular No. 2021-0013 provides additional provisions to give more strength to its 2016 policy.
The policy is now enhanced to strictly monitor fraudulent, unethical acts, and/or abuse of authority among involved hospitals and medical professionals.
“With this new Circular, the Corporation introduced additional provisions that would ensure that due process is observed before any TSPC (Temporary Suspension of Payment of Claims) is finally issued so as to allay fears of alleged arbitrary investigations among our providers,” PhilHealth said in an official statement.
“The Circular was issued in the spirit of proper fund management and fraud control. Fraud control is a basic tenet in managing funds. Hence, PhilHealth finds it imperative to implement measures to ascertain the security and sustainability of funds entrusted to it,” the agency further explained.
With the losses faced due to fraud and overpayment, the state insurer issued Friday the TSPC circular which guides and solidifies their measures in monitoring its funds and identifying potential fraud, abuse, or irrational use of funds behind every claiming transactions.
While the release of the circular helps to observe swindling healthcare performance and management, PhilHealth assures that the reinforced policy will still undergo due process and be imposed in accordance with existing rules and regulations.
“All health care providers can rest assured that this policy will be enforced with respect to due process and existing rules and regulations,” they emphasized.
Furthermore, PhilHealth guaranteed that only those hospitals and healthcare providers “engaged in fraudulent acts against the funds entrusted to the Corporation by its members” will be the focal concern of the policy, asserting that no reasonable claims will be affected.
“PhilHealth assures its members and accredited providers that all good claims shall not be affected by this policy,” the state insurer said.