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Philippine government cracks down on HMO business malpractices



The Philippine Insurance Commission (IC) is imposing penalties on health maintenance organisations (HMOs), in the event of using unsound business practices. HMOs offer a type of managed care designed to maintain the health of their patients cost-effectively. This enforcement, in line with the Financial Products and Services Consumer Protection Act, aims to protect consumers’ rights such as fair treatment, transparency, and data privacy. The IC can now fine HMOs for violations including misrepresentation, unfair discrimination, and poor claims management, with penalties ranging from PHP10,000 (USD178) to PHP200,000, escalating for repeat offences. The policy also allows for the suspension or removal of culpable HMO directors or employees. This regulatory tightening follows a significant net loss of PHP2.15bn in the HMO industry by the third quarter of 2023, amid rising healthcare costs and increased claims.

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