De Lima seeks probe into PhilHealth's reported failure to
release insurance claims to accredited hospitals

Opposition Senator Leila M. de Lima has urged her colleagues to investigate the alleged failure of the Philippine Health Insurance Corporation (PhilHealth) to release insurance claims to its accredited hospitals.

In filing Senate Resolution (SR) No. 461, De Lima said the failure to release the insurance proceeds may endanger the financial viability of the hospitals that can ultimately affect the overall service delivery of the health sector, especially this time of pandemic.

"The capacity of the PhilHealth, as the primary health insurer of the government and as the lead implementer of Republic Act No. 11223, otherwise known as the Universal Health Care Act, to settle health care expenditures and assist public and private hospitals in our health care service delivery is in question," she said.

"The serious allegations of mismanagement and fraud hounding PhilHealth pose serious threats not only to the financial performance and sustainability of the corporation but to its capacity to provide essential health services to the public and to address the health problems posed by the COVID-19 pandemic," she added.

As early as October 24, 2019, the Private Hospitals Association of the Philippines, Inc. (PHAP) revealed PhilHealth's failure to settle its financial obligations to its members and notified the government that these hospitals may cut off their PhilHealth accreditation due to unpaid financial obligations of the state's firm.

Recently, PHAP warned the government that around 300 small private hospitals are already "on the verge of closure" because of influx of non-paying patients, and the much delayed payment of reimbursements under the Interim Reimbursement Mechanism (IRM) assistance to healthcare facilities of PhilHealth, among other factors.

Last June 19, PhilHealth President and CEO Ricardo Morales admitted that the government corporation's operational losses amounting to ₱154 billion due to alleged overpayments and other fraudulent schemes since 2013 has yet to be substantiated and accounted for.

"It is imperative to determine where and how the funds were spent, as well as address the numerous corruption issues at PhilHealth and exact accountability from its leadership," said De Lima, chairperson of the Senate Committee on Social Justice, Welfare and Rural Development.

De Lima pointed out that it is also critical to determine the exact status and financial standing of PhilHealth and its capability to insure and cover basic primary care to health care packages and implement the needed corrective actions to help the country's health care system's response to this pandemic.

"Due regard must also be given to the plight of hospitals and healthcare professionals who depend on the payment of Philhealth for their livelihood, especially the institutions relied upon by our country to help us through this pandemic," she said.

"Now, more than ever, we need our hospitals open and operating as we continue to fight COVID-19 as a country," she added.

In 2019, De Lima filed SR No. 62 urging the appropriate Senate committee to investigate the alleged corruption and inefficiency in PhilHealth that led to operational losses amounting to ₱154 billion since 2013.