Philhealth starts investigation of health care providers

The Philippine Health Insurance Corporation (PhilHealth) has started investigating healthcare providers and individuals that have been involved in fraudulent activities.

PhilHealth President and Chief Executive Officer Dante Gierran (Twitter)

PhilHealth President and Chief Executive Officer Dante Gierran has ordered the profiling of those who are tagged in irregularities, said PhilHealth Vice President for Member Management Oscar Abadu.

"Currently he has started on the profiling of all healthcare providers to see whether there are red flags in these providers and try to address if there are individuals, doctors or healthcare institutions committing acts of fraud," said Abadu.

" first steps  to reorganize the organization and try to address the concerns especially on the issues of irregularities/corruption, and of course fraud committed by hospitals," he added. 

Abadu said that the PhilHealth chief has also partnered with the National Bureau of Investigation and the Presidential Anti-Corruption Commission to identify those involved in fraudulent acts.

Recently, Gierran ordered senior officials of PhilHealth, who are under Salary Grade 26, to submit their respective courtesy resignations. There were 43 officials who heeded to Gierran’s call as of October 8. 

Gierran is also looking at establishing the information technology project of PhilHealth but evaluation should first be conducted, said Abadu.  

To note, the Commission on Audit had flagged the said project due to alleged overpricing. 

“Part of the program is to continue with the IT; critical and vital to PhilHealth’s role is the IT system. But before doing that, he tried to lay down his plans by trying to look at the processes and systems first---and where are the possible gaps and then later on to do the IT intervention,” said Abadu. 

“Everything should start with the current process, the systems, and where are the gaps and  loopholes that need to be addressed so that proper IT solutions shall be provided,” he added.