Hospitals oppose Philhealth’s suspension order

THE Philippine Hospital Association said Tuesday it opposed a government proposal imposing a 90-day preventive suspension on hospitals and their employees with pending administrative cases on alleged fraudulent billings.

The opposition came after the Philippine Health Insurance Corp. issued Circular 47-2009 suspending accredited providers with pending administrative cases

Group president Ruben Flores said their lawyers’ examination of the cases revealed that most of the so-called fraudulent cases were “mere inadvertent mistakes or typographical errors committed in good faith.”

And despite the PHA members’ apologies, PhilHealth’s legal department even used the apologies as evidence of fraud, he said.

“Hospitals are still accused of fraudulent practices when no actual damage and loss has resulted to PhilHealth since the hospitals were not paid their reimbursement claims,” Flores said.

The association said Philhealth’s suspension order, if carried out, meant that any hospital penalized would not be able to provide health care services for 90 days, hence undermining the National Health Insurance Act.

Instead of imposing the suspension, Philhealth’s arbitration department should conduct a hearing so the hospitals could present their side and defend themselves, Flores said.

He said most of PhilHealth’s arbitration board resolutions over hospital practices had resulted in adverse resolutions.

“This opens or increases the prospect of medical malpractice suits against the hospital, he said.

“We need not elaborate the cost entailed by such litigations and the tremendous burden it bears” on the medical industry. –Manila Standard Today