The Commission on Audit (COA) has flagged the Philippine Health Insurance Corporation (Philhealth) for overpaying hospitals for benefit packages and claims for two years in a row.
In its annual audit report, COA said records provided by Philhealth’s regional offices in NCR, CARAGA and regions 1, 8 and 9 showed the state health insurer paid more than P936,652,560 in excess of the actual hospitala charges and professional fees.
COA said the overpayment of reimbursement package rates is considered unnecessary expenses by PhilHealth. Moreover, it is the HCIs who benefited more from receiving excess payment rather than the member-patients.
Considering that this happened twice in a row, COA said that overpayment could be avoided if PhilHealth considered revising the Package Care Rates System. This will provide a policy guideline wherein claims would be based on the actual hospitalization charges plus PF of the member-patients.
Meanwhile, the regional offices already asked for guidance from the PhilHealth HO Management on how to properly address the issue.