PhilHealth to celebrate 13th Anniversary
February 14, 2008 marks the 13th anniversary of PhilHealth as it also celebrates the National Health Insurance month.
It was in February 14, 1995 that the Philippine Health Insurance Corporation (PhilHealth) was established to administer the national health insurance program.
Now, PhilHealth offers five programs for Employed Sector, Individually Paying, Sponsored program for Indigents, Overseas Workers and Lifetime program for Retirees and Pensioners as well as those in their 60s who are able to contribute their 120 month premiums.
As to service, in Region 6 PhilHealth will inaugurate its new Service Office in Passi City on February 14 having now a total of eight Service Offices in the area.
Last year, PhilHealth paid a total of 185,926 patients amounting to P1.3 billion as benefits to members as refund for their hospitalization due to illness or injury, maternity-related benefits and certain out patient cases. Also it has given Capitation Fund to augment financial aid to accredited Health Centers for improvement of facilities, procurement of supplies and remuneration of all health workers.
As it celebrates the month long celebration, series of activities are being implemented in every service office. The Regional Office spearheaded the free blood donation to Philippine National Red Cross by its personnel, conduct of orientations, domiciliary and hospital visitation and the highlight is the Employees Night, a thanksgiving dinner tendered for its entire staff.
At the start of this year PhilHealth welcomes the active support of some local government units which now requires the employers in their respective locality to submit PhilHealth Certification of Good Payment Standing as requirement for issuance of business permits thus, ensuring those working in the informal sector and household help under the national health insurance program.
Currently, PhilHealth issued circular regarding the unclaimed PhilHealth reimbursements to members and the consequential penalties in case of violation that states, "All accredited health care providers who have already been reimbursed in full of the deductions made in the patient-member's account are directed to return to the members the difference thereof within thirty calendar days upon receipt of such refund from PhilHealth." However, in case the accredited health care provider fails to return the difference of the total benefits received from PhilHealth to the member, the accredited health care provider shall return said unclaimed PhilHealth refunds to the corporation within thirty (30) days to be reckoned from the date of expiry of the first 30 days grace period, without any demand.
Additionally, all accredited health care facility shall submit to the corporation a financial report covering the reimbursements received from PhilHealth specifically showing the unclaimed reimbursements due to the members as said report shall form part of the requirements for accreditation effective this CY 2008. To ensure its efficiency, PhilHealth grants reward to people who could provide information for the successful recovery of the unclaimed reimbursements and shall be treated with utmost confidentiality.
On cataract cases, it recently signed a Memorandum of Agreement with the Philippine Academy of Ophthalmology (PAO) to help curb abuses in the National Health Insurance Fund through fraudulent claims by erring doctors.
In PAO's recent Annual Meeting Lorna O. Fajardo, Acting PhilHealth President and CEO and PAO President Dr. Dominga Padilla jointly denounced the practice of some health care providers performing cataract extractions beyond what is considered appropriate and ethical. "These doctors engage the services of agents called 'seekers' who deliver a steady supply of patients, many of whom are PhilHealth members, to avail of huge reimbursements," said Fajardo, stressing that "what is unfortunate here is that these patients are gathered and operated on under compromising conditions."
Patients are reportedly gathered from different far-flung areas supposedly to benefit from a mass cataract operation in the guise of medical missions. "But in truth, they are just being used to defraud PhilHealth in the form of questionable claims. This is why we have taken measures to put a stop to this practice," Fajardo stressed.
The MOA with PAO, a specialty society, is a first in the history of PhilHealth and is unprecedented even during the entire existence of its predecessor, the Medicare Commission which spanned the early '70s to mid-90s.
Padilla assured that they are taking on the challenge as they have recognized the fact that these fly-by-night missions may have been indeed become breeding grounds for the unscrupulous conduct of a very few doctors who happens to be their members. (Larry T. Tabsing)