By Leilani S. Junio
MANILA, July 1 (PNA) — The Philippine Health Insurance Corporation (PhilHealth) said on Wednesday it has suspended payments for reimbursement of two eye care facilities that are currently under investigation for questionable claims.
During the hearing by the Senate Blue Ribbon Committee on the alleged spurious claims made by some hospitals and clinics, PhilHealth President and CEO Alexander Padilla said they stopped the payments of claims of the QC Eye Center and the Pacific Eye Institute based on the post-audit they conducted.
Both eye centers are among the top 10 healthcare facilities and ambulatory clinics under investigation for having high benefit claims for cataract surgeries.
The owners of the two facilities were also invited during the inquiry of the Senate committee chaired by Senator Teofisto Guingona III, together with Senators Joseph Victor Ejercito and Aquilino Pimentel III.
“We are doing this because of the perceived violations of doctors,” Padilla said as he cited that PhilHealth payments processing for such claims were placed on suspension.
When asked why the payment for the facility is the one suspended and not the doctor, Padilla said that since the facility is the one filing the claim, it should be responsible for what is being conducted by the doctor performing the surgeries.
“The one who files the claim is the facility, not the doctor. The one who receives the payment is the facility, not the doctor, so dapat responsable ang facility sa kani-kanilang doctor. Di nila pwedeng gamiting palusot na sasabihin ‘kasi yan ang gawain ng aming doctor’. Di ho pwede yun kasi, otherwise every other doctor in all hospitals will be escaping liability,” the PhilHealth president explained.
He also said there will be other possible suspension of payments in other facilities claiming “suspicious benefits” as the investigation and post-audit continue to roll down.
He added that they will also look soon into claims for other diseases with high number of benefits such as pneumonia, dialysis and others.
In a PhilHealth post-audit, it was learned that certain acts of “hakot” mechanism were allegedly conducted by some facilities.
Some of the respondents in the investigations conducted following the post-audit had revealed that they were made to undergo some procedures not required. One of the said procedures had led to eye blindness.
Meanwhile, Dr. David Harold Gosengfiao, owner of Pacific Eye Institute (PEI) in Makati City, appealed for fair play in the investigation, saying they are not resorting to “hakot” system as method of bringing patients to the eye centers.
Dr. Gosengfiao added that because of the trust they earned from different organizations, it is the senior citizens themselves who approach PEI to avail of its services.
Also during the hearing, Dr. Minguita Padilla, head executive staff of the Department of Health (DOH) Secretary, said that the practices of “seekers” are something that they are very concerned about.
“That is very scary because the people are not ruled by doctor-patient relationship, they are ruled by money… Business na ho,” Padilla said.
She further said that there is a need to stay the sanctity of the medical profession, the dignity of the doctors and the safety of the patients.
PhilHealth is the government’s premier health insurance program aimed at providing affordable health care to Filipinos. (PNA)