PhilHealth clarifies issue on claims payment

By : Mindanao Today/08:26:11pm 08/26/2021


IN relation to the issuance of PhilHealth Circular No. 2021-0013 suspending payment of claims that are subject of investigation pertaining to fraudulent, unethical acts, and/or abuse of authority, the Philippine Health Insurance Corp. PhilHealth) clarified that this policy has been in place since 2016 (PhilHealth Circular 2016-026), said Dr. Shirley Domingo, vice president for corporate affairs and official spokesperson.

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 investigation among our providers.

The Circular was issued in the spirit of proper fund management and fraud control. Fraud control is a basic tent in managing funds.

Hence, PhilHealth finds it imperative to implement measures to ascertain the security and sustainability of funds entrusted to it.

All health care providers can rest assured that this policy will be enforced with respect to due process and existing rules and regulations.

Likewise, this policy will affect only providers engaged in fraudulent acts against the funds entrusted to the Corporation by its members.

PhilHealth assures its members and accredited providers that all good claims shall not be affected by this policy. (PR)

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