BAGUIO CITY (PIA) – The Philippine Health Insurance Corporation-Cordillera (PhilHealth-CAR) reported a decrease in cases filed against health care providers, facilities, and professionals in 2024.
PhilHealth-CAR Legal Section Head Atty. Eric Mandiit said that out of 285 claims endorsed for investigation and validation in 2024, only 15 cases were filed. Said number is lower compared to the 65 cases filed in 2023 out of 208 claims endorsed for investigation and validation.
Mandiit said they attribute the decrease in cases to better communication and monitoring methods that improved their relationships with healthcare facilities.
“We attribute this to the constant communication with the facilities. We also have to reach out to these facilities, alamin namin kung ano talaga ang problema and gumanda po,” he stated.
Mandiit also stressed the importance of staying in touch and regularly checking on healthcare facilities including patients.
“May constant monitoring din kami sa mga facilities. Every now and then, vini-visit namin sila, tinitingnan din namin, tinitingnan din namin ‘yung mga problema, we validate, we also conduct monitoring by patients … may visit din kami sa mga patients to validate din po kung tama po ba ‘yung mga benepisyong naibigay sa kanila,” he said
Mandiit explained that when they receive a complaint, they conduct the necessary investigation before filing a complaint affidavit to the PhilHealth prosecution department to determine if there is enough evidence.
Once a prima facie case is determined, the case will be elevated to the adjudication office, also within PhilHealth, for the conduct of hearing.
He mentioned that some of the cases filed are already in the prosecution department while some are undergoing hearings at the adjudication office.
Meanwhile, he reminded the employers to remit the correct PhilHealth contributions of their employees on time.
PhilHealth Advisory No. 2025-0002 states that the premium rate effective the applicable period of January 2025 remains at 5.0 percent, with an income floor of P10,000 and an income ceiling of P100,000.
All employers are reminded to use the monthly basic salary in the computation of monthly contributions of their employees. [JDP/DEG/Trixie Cabico – PIA-SLU Intern]
