In relation to the issuance of PhilHealth Circular No. 2021-0013 suspending payment of claims that are subject of investigations pertaining to fraudulent, unethical acts, and/or abuse of authority, the Philippine Health Insurance Corporation (PhilHealth) clarified that this policy has been in place since 2016 (PhilHealth Circular 2016-026). According to PhilHealth, with this new Circular, the Corporation introduced additional provisions that would ensure that due process is observed before any TSPC (Temporary Suspension of Payment of Claims) is finally issued so as to allay fears of alleged arbitrary investigations among our providers.
The Circular was issued in the spirit of proper fund management and fraud control, PhilHealth said. Fraud control is a basic tenet in managing funds. PhilHealth therefore finds it imperative to implement measures to ascertain the security and sustainability of funds entrusted to it, the agency added.
PhilHealth stressed, “All health care providers can rest assured that this policy will be enforced with respect to due process and existing rules and regulations. Likewise, this policy will affect only providers engaged in fraudulent acts against the funds entrusted to the Corporation by its members.”
PhilHealth assures its members and accredited providers that all good claims shall not be affected by this policy.
