COA claims PhilHealth refund program a failure

THE Commission on Audit (COA) opined that the refund program of the Philippine Health Insurance Corp. (PhilHealth) is a failure since only two percent of the total P142.39 million refundable money was returned.

In their 2010 report on PhilHealth, state auditors said that the government’s health insurance company is facing problems in refunding unclaimed benefit.

Unclaimed refunds pertain to the difference between the amount PhilHealth paid as reported by various hospitals and clinics and the actual amount deducted by the medical institutions as PhilHealth benefit upon discharge of the member from hospital confinement.

The difference should be returned to respective members as refund.

According to COA, only two percent as of 2010 of the P142.39 million had been returned to members who had unclaimed refunds.

In Metro Manila, Institutional Health Care Providers (IHCPs) returned a total of P18.41 million to PhilHealth in 2010, increasing the total unclaimed benefit refunds to P119.70 million as of 2010 yearend.

This, however, “a very minimal amount of P298,107, which is even less than one per cent of the total unclaimed refund at year end, was refunded by PhilHealth to its members,” COA bared.

Because of PhilHealth’s failure “to return the unclaimed refunds, [it] deprived the rightful member-beneficiaries of the maximum benefit due them.”

PhilHealth said that they could not verify the rightful claimants of the refund because not all ICHPs—the hospitals or clinics—comply with needed requirements.

COA found out that less than half of the 246 total accredited IHCPs in Metro Manila submit the Report on Unclaimed Refund (RUR), an essential document that traces the rightful beneficiaries of unclaimed refunds.

Only 106 ICHPs submitted their RURs in 2010.

The RUR details the names of member-patients, confinement dates, amount reimbursed by PhilHealth, amount deducted from member-patient and amount to be refunded.

It shows the amount of unclaimed refunds that accumulated in the hands of the IHCPs since 1995.
The Commission said that the refund failed because of lack of cooperation of ICHPs in submitting needed documents and the absence of monitoring of PhilHealth.

“The absence of monitoring on the submission of annual [financial statements] and RUR and the failure to impose sanctions on those accredited institutions, resulted in the slow or non-recovery of unclaimed refunds,” COA said.

“The thrusts to ensure that all reimbursements are refunded to the rightful claimants and to eliminate the accumulation of refunds in the ICHPs were not completely attained,” the Commission opined.

COA said that PhilHealth should impose sanctions against erring ICHPs who do not submit the requirements to recover unclaimed refunds from them which, in turn, will be refunded back by PhilHealth to the rightful member-claimants. –John Constantine G. Cordon, Manila Times