Commission on Audit: Lung Center failed to refund P22.6M PhilHealth members’ claims

OUT of the P28 million collections from the Philippine Health Insurance Corp (PhilHealth), the Lung Center of the Philippines (LCP) only reimbursed some P5.4 million to eligible members, according to the Commission on Audit (COA) annual report.

The COA report called the attention of the LCP to its failure to refund more than P22.6 million.

The report said for the last six years or from 2012 to 2018, the LCP has not settled P22.6 million worth of reimbursement claims of eligible members of the PhilHealth.

The yearly unrefunded amounts, according to COA, ranged between P132,710 to P5.68 million.

“The lapses of the LCP deprived the concerned patient-members of their benefit,” the COA said.

The auditors added that this was also contrary to PhilHealth Circular No. 42, series of 2009, which requires accredited health care providers to refund the benefit claims of members within 60 days after its receipt from the state insurance firm.

“The patients refund from PhilHealth is a benefit payment that should be reimbursed by the accredited hospital to the patient-member for a specific confinement period,” the COA said.

“The refund resulted from either an under-deduction or non-availment of benefits at point-of-service due to various circumstances at the time of hospitalization,” it added.

As stated in PhilHealth Circular No. 42, series of 2009, the LCP should have remitted the unclaimed refunds back to PhilHealth within 30 days.

Because of this, the agency has urged the public hospital to “exert all efforts” in ensuring the refund to PhilHealth members.

For its part, the LCP management already told the COA that it has assigned personnel to review the amounts in the PhilHealth Medicare Patients Refund account to ensure the accuracy of the refunds.

The eligible claimants will be notified of their refunds, but LCP vowed to remit the funds back to PhilHealth in case the member is no longer located.

The COA vowed to continue monitoring the full compliance of the LCP for 2019.