Mahigit limang milyong maralitang pamilya ang pinagkaitan ng medical health benefits kahit binayaran nang buo ng pamahalaan ang kanilang health insurance premium sa Philippine Health Insurance Corporation (PhilHealth) na nagkakahalaga ng P12.3 billion.
Ibinunyag din ng Commission on Audit sa 2014 annual audit report nito para sa PhilHealth na maraming miyembro ang napagkaitan ng full health benefits dahil nabigo ang ahensiya na ibalik sa claimants ang kabuuang P325.24 million sa reimbursements na ibinalik ng mga institutional health care provider.
“PhilHealth billed the Department of Health (DoH) the amount of P35.296 billion corresponding to the health insurance premium of 14,706,524 indigent families. PhilHealth was paid the amount billed but was able to enroll only 9,546,439 indigent families, thus, overbilling DoH an excess health insurance premium of P12.384 billion,” bunyag sa CoA report.
Ipinaliwanag ng state auditors na sa ilalim ng insurance program para sa mga maralitang pamilya, binayaran ng DoH ang health insurance ng mahigit 14 milyong maralitang pamilya na tinukoy ng Department of Social Welfare and Development.
Empleyadong lasing, patay matapos sapakin ng ginising na katrabaho
Alinsunod sa 2014 General Appropriations Act, inilabas ng DoH sa PhilHealth ang hinihinging halaga na ipambabayad sa insurance premium ng mga maralitang pamilya.
Gayunman, batay sa datos na ibinigay ng Task Force informatics, 9 na milyon lamang sa 14 milyong benepisyaryo ng programa ang tunay na naka-enroll.
Binanggit ng CoA na imbes na iklase ang excess health insurance payments sa ilalim ng Other Deferred Credits account, itinuring ng CoA ang sobrang halaga bilang income.
Pumayag ang PhilHealth na gamitin ang sobrang halaga “for future consideration”.
Ibinunyag ng CoA na patuloy na hinahawakan ng PhilHealth ang P325.214 million na kumakatawan sa excess payment para sa health benefits ng mga member claimant.
“Member-claimants were deprived of the full health benefits due them because unclaimed health benefits returned by various Institutional Health Care Providers (IHCP) in the amount of P325.214 million as of December 31, 2014 remained in the custody of PhilHealth,” saad sa audit report.
Sinabi ng mga auditor na ang unclaimed benefits ay dapat na ibinalik sa member-claimants ng mga IHCP sa loob ng 60 calendar days mula sa pagtanggap ng reimbursement mula sa PhilHealth.
“The accumulation of unclaimed benefits was an indication that PhilHealth Management had not given priority for its refund which was disadvantageous to the affected members,” sabi ng CoA.
Idinagdag ng audit body na: “PhilHealth is duty bound to give the full health benefits due to the members in return to the health insurance premium of members paid.”
Ikinalungkot ng mga auditor ang non-refund ng excess payment na lumalabag sa mandato ng ahensiya na pagkalooban ng health care services ang mga Pilipino, “especially to the segment of the population who cannot afford such services.”
“We recommended the immediate refund of the unclaimed benefits to the members and the completion of the refund process be time bound,” anang CoA at nanawagan sa PhilHealth na lumikha ng isang special team para magpatupad nito.
Bilang tugon, nangako ang PhilHealth management na titiyakin na ang mga miyembro ay may unclaimed refunds “will get their money back.” (BEN ROSARIO)
