Baguio: The Philippine Health Insurance Corp. (PhilHealth) is investigating 1,000 suspected cases of 'ghost patients' linked to questionable claims already paid to various health care providers. Lawyer Eric Mandiit, head of PhilHealth-Cordillera's legal unit, disclosed that the incidents involve individuals listed as having used PhilHealth benefits between 2022 and 2024 but were later found to have never sought treatment. Notably, some individuals were reported to have died before the dates of the supposed medical services.

According to Philippines News Agency, PhilHealth has also uncovered instances of double claims, including cases where a patient was reported to have undergone dialysis in two different facilities on the same date. Similar 'ghost patient' cases have been detected under the Yaman ng Kalusugan Program (YAKAP). The total amount paid for these questionable claims is estimated at PHP680,000.

Mandiit explained that some incidents came to light when members received text notifications that PhilHealth had paid claims for treatments they never availed of. Others were discovered during walk-in inspections and routine monitoring of health facilities. To prevent fraud, PhilHealth conducts legal and provider summits, unannounced facility inspections, claim validations through home visits, and text alerts to members regarding benefit utilization.

PhilHealth-Cordillera information officer Magnolia Del Rosario emphasized that the agency now prioritizes text notifications, noting that mailed letters often fail to reach members and result in unnecessary costs. Del Rosario added that once due process is completed and a health facility is found liable, penalties under Republic Act 11223, including suspension of accreditation and fines, may be imposed.