The Philippine Health Insurance Corp. (PhilHealth) has partially restored effective this week the accreditation of two Koronadal City-based hospitals following allegations of fraudulent activities.
Ricardo Morales, PhilHealth president and chief executive officer, said they have decided to recall the withdrawal of accreditation it earlier issued against the Dr. Arturo P. Pingoy Medical Center (DAPPMC) and the Allah Valley Medical Specialists Center Inc. (AVMSCI).
Morales the two hospitals have been temporarily allowed to continue rendering services to its members for procedures that are not covered by the ongoing investigation against them.
“Pero yung mga procedures na nasangkot sa mga suspected fraud, yun ititigil muna (But procedures that are involved in suspected fraud, they will be stopped for now),” he said in an interview over the Radio Mindanao Network in Koronadal City on Wednesday.
In a public advisory issued on Oct. 10, PhilHealth-Region 12 (Soccsksargen) announced that it has withdrawn the accreditation of DAPPMC and AVMSCI effective the same day for alleged involvement “in the commission of fraudulent activities.”
It also suspended for six months the General Santos Doctors Hospital Inc. here effective last Monday, October 21, but the implementation has been “held in abeyance” based on an order from its arbitration office.
Early this week, Morales said he spoke with the medical directors of the two hospitals who agreed to review their systems and processes.
He said PhilHealth agreed to limit the sanctions meted after the discovery of the alleged fraudulent procedures until the final resolution of the cases.
Morales said they are set to issue the guidelines for the initial arrangement and the medical procedures that will not be included in the PhilHealth coverage.
He said the supposed violations committed by DAPPMC and AVMSCI do not include dialysis services, noting that he only mentioned it as an example during a previous interview in Manila due to the “WellMed controversy.”
WellMed, a dialysis center based in Metro Manila, is undergoing investigation for allegedly claiming PhilHealth reimbursements for alleged “ghost patients.”
Morales said DAPPMC and AVMSCI are allegedly engaged in “upcasing” or elevating of cases of admitted patients to increase their reimbursement claims from PhilHealth.
He cited, for example, a patient admitted with colds or upper respiratory (tract) infection but reported to the agency as pneumonia cases.
The agency is currently identifying the procedures involved in the alleged “upcasing” and will disseminate them to the public through PhilHealth-Region 12, he said.
Morales said the investigation against DAPPMC and AVMSCI will continue on their level and they are currently in the process of “collecting pieces of evidence, affidavits, and records” pertaining to the cases.
He assured that the concerned hospitals will be given due process and the chance to answer for the alleged violations.
“We have to get to the bottom of this. It involves the people’s money so we have to be extra careful,” he said.
Dr. Antoniette Ladio, PhilHealth-12 acting regional vice president, earlier said the withdrawal of accreditation to DAPPMC and AVMSCI is a form of “preventive penalty.” (PNA)