SPMC denies making money on Covid-19 cases

An official of the Southern Philippines Medical Center (SPMC) belies accusations by some individuals that the hospital is making more money if patients are listed as Covid-19 and could gain more from PhilHealth if they are declared severe or critical. 

The rumors started to spread when some families complained about their patients listed as Covid-19 cases when brought to SPMC even if the cause of deaths were of reasons other than Covid-19. 

These reports also gave rise to the “scamdemic” term used by those who think the pandemic is just a hoax.  

“What will the staff gain from this when SPMC is a government hospital?  Any income that the Philippine Health Insurance Corporation (PHIC) will pay us is duly accounted for in accordance with existing accounting and auditing rules,” said Barbara Cezar, financial and management officer of SPMC, in an email interview. 

Cezar said the clinical chart is a legal document and any diagnosis that the medical doctor will encode in the chart is supported by tests and examinations on the patient, therefore, cannot be manipulated.

“The Covid positives are really based on PCR. The transmission of the virus is real. I don’t think the hospital will falsify data since it’s going to be fraud,” said Department of Health (DOH) Undersecretary Leopoldo “Bong” Vega, former chief of hospital of SPMC, in a telephone interview.

SPMC, the biggest government hospital in the country with 1,500 beds, is considered as the ground zero for Covid-19 treatment not only in Davao City but Davao Region and Mindanao as well thus maximizing its manpower and resources and streamlining its Covid-19 response.

There are about an average of 800 to 1,000 patients a day being tested for Covid-19 at SPMC.  As of October 31, 2020, the hospital has tested a total of 91,728 patients. 

“We are still given the testing kits and reagents by the Department of Health (DOH),” Cezar said. According to Vega SPMC receives about P300,000 per severe Covid-19 patient and P700, 000 for each critical Covid patient from PhilHealth.

Cezar shared to Edge Davao the PHIC packages of Covid-19 patients wherein for mild cases P43,997; moderate P143,267; severe P333,519; and critical P786,384 per Covid-19 patient. 

Cezar emphasized that since SPMC started Covid-19 admissions in March, the hospital has not received any payment for its claims for Covid-19 cases since PHIC added a requirement for these claims.   

“We still have to retrieve the clinical chart of the patients for submission to PHIC to support our claims. Although, in the PHIC circular issued, there was no requirement of a copy of the whole chart of the patient. However, PhilHealth Regional Office 11 (PRO 11) issued an advisory in August, 2020, requiring us to submit a copy of the whole chart of the patients,” she explained.   

Cezar added that SPMC still needs to undergo the process of retrieving the records and have to comply with the subsequent requirement for the hospital to get paid.   

She said PHIC will not pay the hospital’s claims unless substantiated with data that will justify the claims.  

“We cannot in any way manipulate records and once diagnosed as Covid-19 positive, the patients have undergone laboratory and CT scan and x-rays. The medicines and medical supplies that we used for these patients are all documented,” she said.

Cezar explained for Covid-19 patients, the hospital even spend more than the package rate being paid by PHIC.  

SPMC’s unpaid claims from PhilHealth reached P95,738,098.78 for a total of 760 cases from March 2020 to September 2020. For the month of March SPMC’s claims is P836,797.88 with seven Covid-19 cases; P10,924,296.26 for April with 63 cases; P10,561,128.04 for May with 45 cases; P9,623,808.30 for June with 82 cases; P17,498,962.40 for July with 156; P18,759,637.90 for August with 210 cases; and P27,533,468 for September with 197.  

“We are also under the order of PHIC to charge our patients only with the PHIC case rate.  Any excess from the hospital charges is subsidized by the hospital, hence, walang binayaran ang mga pasyente and all their medications are provided by the hospital,” Cezar said.