PhilHealth intensifies anti-fraud drive for UHC implementation

MANILA -- The Philippine Health Insurance Corporation (PhilHealth) has intensified its campaign against fraud to ensure full implementation of the Universal Health Care law, an official of the agency said on Thursday.

In a statement, PhilHealth acting president Roy Ferrer said it has partnered with government agencies, including the National Bureau of Investigation (NBI) to go after health institutions and professionals involved in misconduct, breach in accreditation, claims for deceased patients and other grounds for punishment.

Ferrer added PhilHealth has signed a memorandum of agreement with the NBI in line with their anti-fraud campaign.

He said the Philippine Medical Association and Philippine Hospital Association helped PhilHealth confront concerned hospitals while the Professional Regulation Commission sanctioned the dishonest health professionals.

"Last year, PhilHealth filed about 5,000 cases against health care institutions and professionals. The corporation only takes 17 days to process a case build-up that entails a thorough data-gathering method. Fraudulent transactions spanning from professionals recruiting members into a bogus Free Wellness Program only to be paid for by PhilHealth to hospitals and dialysis centers including filing claims for deceased patients were exposed," Ferrer said.

The PhilHealth has already penalized 71 hospitals nationwide due to breach in accreditation and misconduct.

"Moreover, members of the so-called 'mafia' within its ranks have been uncovered and suspended by PhilHealth due to a string of offenses against the Corporation. Stiff penalties and fines were imposed upon those involved and measures were formulated to prevent future occurrence of fraud," the PhilHealth statement read.

In an earlier interview, Ferrer said PhilHealth is also investigating private hospitals for reportedly filing claims without supporting documents as the corporation cannot dispense public funds to cover questionable charges.

Source: Philippines News Agency