Over P900M PhilHealth Overpayments In 2019 – COA

COA Uncovers P900M PhilHealth Overpayments In 2019

PHILHEALTH ISSUE – The Commission on Audit (COA) recently uncovered more than P900M worth of “overpayments” from PhilHealth in 2019.

The issues surrounding the state-run insurance firms seem to be a gift that keeps on giving. Following the numerous alleged anomalies within the company, COA auditors have noted a “recurring” issue with “overpayments” to health care institutions.

Earlier, COA published on its website a 2019 audit report for PhilHealth. In the report, COA stated:

Full reimbursements of the package rates (All Case Rates (ACR) and Z Benefit) to various Health Care Institutions (HCIs) for 312,577 sampled claims despite the lower member-patients’ actual hospital charges plus the maximum amount of Professional Fees (PF) resulted in an overpayment of ₱936.653 million,

Over P900M PhilHealth Overpayments In 2019 – COA
Image from: CNN

Along with this, COA highlighted that some accredited health service providers have been overpaid by the health insurer. Furthermore, the majority of these payments were under PhilHealths’ case rate system. Meanwhile, some lawmakers had already voiced concerns regarding the system as it allegedly began a culture of corruption.

COA also noted that CARAGA got the biggest share of excess reimbursements under the system with P375,160,840. Metro Manila follows this with P364,084,352. Afterward, facilities from the Zamboanga Peninsula received P192,346,970 for reimbursements.

With PhilHealth’s case rate scheme, the cost of treating certain diseases such as pneumonia has a fixed rate. This meant that if the illness is pneumonia, regardless of the accumulated expenses a patient gets for that treatment, the health insurer pays a fixed price for it.

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