PhilHealth to public: Report cases of upcasing, health insurance abuse

Published April 12, 2021, 6:32 PM

by Leslie Ann Aquino

 The Philippine Health Insurance Corporation (PhilHealth) has appealed to the public to report cases of upcasing or any form of health insurance abuse.

The agency issued the call, noting the proliferation of video posts supposedly relating to incidents of health care providers colluding with patients to declare minor respiratory symptoms such as asthma as coronavirus disease (COVID-19) to claim higher benefits.

In a statement on Monday, April 12, Philhealth enjoined those who posted the videos to provide the necessary proof and fully cooperate with the probe. 

The state health insurer said that if found to be true, the incidents described in the video posts refer to upcasing or claiming for a related illness or procedure of higher severity or complexity to gain higher benefit payment.

Philhealth said upcasing is a form of health insurance fraud punishable with a fine of P200,000 for each count, or suspension of contract up to three years of the health care provider, or both. 

It also constitutes a criminal violation punishable by imprisonment for 6 months and one day up to six years upon the discretion of the court in accordance to Section 38 of the Universal Health Care Law.  

PhilHealth reminded the public that protecting the PhilHealth fund is also a responsibility of every member. 

It appealed to everyone who is in possession of credible information on such unethical acts to report directly to PhilHealth together with evidence so that the agency can act swiftly.  

PhilHealth also reiterated that the National Health Insurance Fund is a public fund, and any form of abuse shall be dealt with in accordance to the law. 

It also warned that those who post such information without any proof to support their claims are not helping insofar as making the public at ease in the face of the COVID-19 pandemic. 

They instead malign and compromise the reputation of hospitals, doctors and even the agency itself, acts that may lead to legal actions such as cyber libel and violation of Article 154 of the Penal Code criminalizing publication of false information that may endanger the public order or cause damage to the interest or credit of the State, the state health insurer said.

Philhealth said concerned citizens and whistleblowers were encouraged to report such cases through the following channels: 

Face-to-face meetings (observing minimum health protocols): Nearest PhilHealth offices  

Email:[email protected][email protected];[email protected]  

Mail: Room 1711, 17th Floor Citystate Centre, 709 Shaw Boulevard, Pasig City

Telephone: (02) 8441-7442

“PhilHealth assures utmost confidentiality of reports as well as protection and possible assistance to the whistleblower as provided for by law,” it said.