The Philippine Health Insurance Corp. (PhilHealth), has suspended and withdrawn the accreditation of three major private healthcare providers in Region 12 (Soccsksargen) due to alleged fraud.
Dr. Antoniette Ladio, acting regional vice president of PhilHealth-12, said on Saturday they issued a writ of execution of suspension to the General Santos Doctors Hospital Inc. (GSDHI) here.
Ladio said notices of withdrawal or revocation of accreditation were also issued against the Dr. Arturo P. Pingoy Medical Center (APPMC), and the Allah Valley Medical Specialists Center Inc. (AVMSCI), both based in Koronadal City.
Ladio said GSDHI was suspended “for violation of the pertinent provisions of Republic Act 7875 or the amended National Health Insurance Act of 2013.”
The APPMC and AVMSCI, he added, are suspected for involvement “in the commission of fraudulent activities.”
The suspension of GSDHI will take effect on Oct. 21 until Jan. 18, 2020 and from Jan. 19 to April 17, 2020 or about six months while the withdrawal of accreditation for APPMC and AVMSCI officially took effect last Oct. 10.
The decision was based on PhilHealth Board Resolution No. 2406, series of 2018, on case numbers HCP-XII-08-007 and HCP-XII-08-014.
PhilHealth-12 initially issued a public advisory regarding the accreditation status of the three hospitals on Thursday.
In the case of APPMC and AVMSCI, Ladio said their central office issued a memorandum last June 13, 2019, recommending the withdrawal of their accreditation after being “suspected of engaging in fraudulent activities.”
He said PhilHealth has the authority to grant health care providers or hospitals with accreditation, which confers them the privilege to participate in the National Health Care Insurance Program.
“In the same manner, the corporation has the authority to deny or withdraw the accreditation of a health care provider after an evaluation of its capability and integrity in accordance with (its) guidelines, standards and procedures,” he said in a statement.
Ladio noted that as a policy, PhilHealth members and their eligible dependents are entitled to avail of benefits under the National Health Insurance Program only in health care providers accredited with the agency.
With the suspension and withdrawal of their accreditation, he said PhilHealth will not receive, process and pay any claims of benefits for confinements or services rendered involving the three hospitals.
Ladio advised PhilHealth members and their beneficiaries who need medical treatment or services and confinement to go instead to an accredited health care provider to ensure the continuous availment of benefits.
Hanah Naanep, PhilHealth-12 public information officer, declined to comment regarding the violations of the concerned hospitals but said she has referred queries from the public and the media to their legal division and top officials.
In a press conference in June, PhilHealth-12 admitted that it was investigating a doctor and at least three local hospitals due to fraudulent health insurance claims.
Lawyer Jusen Lubaton, then PhilHealth-12 legal services chief, said their fact-finding investigation focused on the alleged connivance by a Koronadal City-based doctor, who was not named, with at least three hospitals to defraud the agency through falsified claims.
Ronald Echon, AVMSCI administrator, declined to disclose the reason for the withdrawal of their accreditation but said they already filed a motion for reconsideration with PhilHealth.
Echon said he cannot discuss the details of the case and “as far as I know, PhilHealth is only following its protocols.”
“As of now, we just follow the process. We received the communication so we follow. We explain the situation to our patients and also doing our best to resolve the matter with PhilHealth,” he said in an interview on Saturday over radio station Brigada News FM in Koronadal City.
He clarified that patients who were admitted to the facility prior to the Oct. 10 withdrawal are still covered by PhilHealth insurance but those served from the same day onwards can no longer avail of its packages.
In their appeal, Echon said they sought for the immediate reinstatement of their accreditation so they can continue rendering services to PhilHealth members in the area.
Echon said the withdrawal has not only affected patients from South Cotabato and Koronadal City but also those from the neighboring provinces and cities.
He said these include patients who are availing of their dialysis treatment on a daily basis.
“Despite our situation, rest assured that we will continue to serve and not abandon our patients. We discussed some strategies and came up some options that can help them in the process,” he added. (PNA)