Despite the provisions set forth in the PhilHealth Implementing Rules and Regulations and PhilHealth Circular No. 027, s-2000 mandating accredited health care providers and professionals to return to the member the difference of the PhilHealth benefits paid in full, it has been noted that unclaimed reimbursements due to members abound and has been accumulating in the hands of health care providers and professionals.

        In view of this, with the aim of ensuring that all PhilHealth benefit reimbursements are eventually refunded to and received by the rightful members and of eliminating the accumulation of such refunds in the hands of accredited health care providers and professionals, all accredited health care providers who have already been reimbursed in full of the deductions made in the patient-member’s accounts are directed to return to the members the difference thereof within thirty (30) calendar days from the receipt of such refund from PhilHealth.

        Moreover, all accredited health care providers shall submit to the Corporation a financial report covering the reimbursements received from PhilHealth specifically showing the unclaimed reimbursements due to PhilHealth members as this said report shall form part of the requirements for accreditation effective 2008.

        Non-compliance shall constitute a violation of and shall be penalized in accordance with the pertinent provisions of RA 7875 otherwise known as the National Health Insurance Act, as amended, and its Implementing Rules and Regulations, as amended, without prejudice to the filing of appropriate civil and/or criminal complaint against the erring health care provider, (as per PhilHealth CircularNo. 15, s- 2007).

        To properly define the guidelines on how to return to PhilHealth the unclaimed refund, PhilHealth Circular No. 01, series of 2008, has been recently issued. It now states that, “... all accredited health care providers who have already been reimbursed in full of the deductions made in the patient-member’s accounts are directed to return to the members the difference thereof within thirty (30) calendar days from the receipt of such refund from PhilHealth. However, in case the accredited health care provider fails to return the difference or the total benefits received from PhilHealth to the member, the accredited health care provider shall return said unclaimed PhilHealth refunds to the Corporation within thirty (30) days to be reckoned from the date of expiry of the first 30-day grace period, without need of demand. In addition, a duly accomplished Financial Report (format to be requested from PhilHealth) on Unclaimed Refunds shall also be required. The Financial Report shall be used for the purposes of reconciliation and accounting of records... “The said Circular also states that this Order is to take effect immediately.