HMO industry group backs IC order vs Caritas Health Shield

MANILA, Philippines — The industry group of health maintenance organizations in the country is backing up the Insurance Commission’s (IC) order that Caritas Health Shield Inc. stop selling and transacting new HMO (health maintenance organization) products and businesses due to alleged fraud.

“The Caritas Health Shield problem in the HMO industry is truly unfortunate and disheartening. In the interest of the buying public, we welcome the IC’s timely issuance of an order to Caritas Health Shield to cease and desist from selling HMO products and/or transacting new HMO business effective immediately,” Association of Health Maintenance Organizations of the Philippines Inc. (Ahmopi) Carlos D. Da Silva said in an e-mail to the Inquirer Wednesday night.

“Pursuant to IC Circular Letter 2018-14 dated Jan. 30, 2018, the Ahmopi stands committed to resolving with dispatch issues and concerns brought to its attention by the IC for handling, the Caritas complaint cases included,” Da Silva said.

“The HMO industry has long been acknowledged as an integral part of the country’s health delivery systems, having been in existence for over four decades and counting. It has likewise been brought into many Republic Acts and/or health bills of late, such as RA No. 11223 or the Universal Health Care Act; RA 11215 or the National Integrated Cancer Control Act; and RA 111661 or the Philippine HIV-AIDS Policy Act. To date, it has an estimated six million plan holders nationwide,” Da Silva noted.

For its part, Caritas Health Shield president and chief executive Mariano T. Katipunan Jr. said in a July 10 announcement that the company “deplores and protests” the IC’s order, hence will file a petition for the regulator to lift it.

“While there were complaints of unauthorized swiping and misrepresentation in some of our mall marketing units, these represent only 0.58 percent of total plans sold from 2016 to 2019. We have sufficiently addressed practically all of such complaints to the satisfaction of the complainants. We do not condone any fraudulent act committed by unscrupulous individuals who have made their way into our organization. We have always acted promptly and terminated those found to have committed such acts,” Katipunan said.

According to Katipunan, Caritas Health Shield last June 17 already stopped operating its mall marketing units that had been subject to complaints.

Caritas Health Shield had also informed the IC of their move to resolve the previous complaints against unscrupulous agents, hence the company was “saddened and surprised” by the regulator’s cease-and-desist order.

“We assure the public that we shall continue to service the health care requirements of all our bona fide members,” Katipunan said, citing that Caritas Health Shield has been in the business since 1995.

On Tuesday, the IC said Insurance Commissioner Dennis B. Funa last July 8 issued the cease-and-desist order against Caritas Health Shield following “numerous complaints received by the IC on the alleged fraudulent swiping of credit/debit cards and alleged misrepresentations of the company’s sales agents.”

Funa nonetheless ordered Caritas Health Shield to continue honoring its existing contracts with members while also providing “uninterrupted” services to plan holders.

The IC chief will appoint an overseer to ensure that Caritas Health Shield will comply with his directive. /muf