PhilHealth warns public, doctors engaging in fraudulent health claims

Published May 7, 2021, 1:00 PM

by Jhon Aldrin Casinas

The Philippine Health Insurance Corporation (PhilHealth) on Friday, May 7, renewed its warning against illegal acts of fraudulent health insurance claims.

Philippine Health Insurance Corporation (PhilHealth) (MANILA BULLETIN)

PhilHealth spokesperson Dr. Shirley Domingo said they received various reports relating to misrepresentation or providing false information, upcasing of claims, unnecessary hospital admission, and ghost patients.

“Ang pondo ng PhilHealth ay pondo ninyo. Protektahan po natin ang pondong ito. Huwag po nating abusuhin ang pondong ito (PhilHealth funds are your funds. Let us protect this fund. Let us not abuse this fund),” Domingo said in a public briefing.

“Huwag po tayong mag-fraud practices kasi kung maubos ito kayo rin po ang mahihirapan kung wala nang pondo o bumaba ang pondo ng PhilHealth (Let us not engage in fraud practices because if the funds run out, you will have a hard time PhilHealth’s funds will run out or decrease),” she added.

Domingo said they are currently investigating cases of doctors and other health care providers allegedly engaging in fraudulent health insurance claims.

The PhilHealth official said that the agency received reports of around 2,000 cases of fraudulent practices in 2020, and around 900 cases of alleged illegal practices as of date.

Domingo said health care providers found committing insurance claim fraud could have their accreditation with the agency revoked permanently, while healthcare professional involved in illegal acts could have their license revoked by the Professional Regulation Commission.

PhilHealth has earlier advised health care providers not to engage in unethical acts such as upcasing of claims after receiving reports relating to health care providers colluding with patients to declare minor respiratory symptoms as COVID-19 case for higher benefit reimbursements.

“We call on the public to cooperate with us to immediately curtail these wrongdoings. We should protect the National Health Insurance fund, because it is a public fund, it is your money,“ PhilHealth President and Chief Executive Officer Dante Gierran said in a statement.

PhilHealth has urged the public to report fraudulent acts by sending them an email at [email protected]; [email protected]; and [email protected] or by mail addressed to the Office of the Corporate Secretary, Room 1711, 17th Floor Citystate Centre, 709 Shaw Blvd., Pasig City.