MANILA, Philippines — While the Philippine Health Insurance Corp. (PhilHealth) All Case Rate payment scheme sped up the reimbursement process, it lacked control mechanisms to detect and prevent improper payments, the Commission on Audit (COA) said Wednesday.
COA found this after it conducted a performance audit of the ACR scheme covering its implementation in 2022 until June 30, 2020.
Under the ACR scheme, PhilHealth pays all claims using a case rate or a fixed rate for each covered case or disease. This aimed to incentivize health care institutions to be more efficient.
“If the case rate for a specific treatment is lower than the actual c…
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