Metro Manila (CNN Philippines, June 1) — The Philippine Health Insurance Corporation said it has been receiving reports about hospitals declaring their COVID-19-related claims as less severe than the patients’ actual conditions out of their fear of being left unpaid.
During the hearing of the House Special Committee on the North Luzon Growth Quadrangle on Tuesday, PhilHealth vice president for Area 1 Walter Bacareza said some hospitals are “downcasing” as they fear the state health insurer will not be able to pay the claims.
“Marami kaming naririnig na ganoon. Noong unang panahon ang tawag diyan ‘upcasing’, ‘yung simple ginagawang grabe. Ngayon nababago na, ‘downcasing’ naman. ‘Yung grabe ginagawang simple,” he said.
[Translation: We are receiving a lot of reports like that. This was first called “upcasing”, making simple cases worse. Now it has changed, it is now “downcasing”. The grave cases are made simple.]
Bacareza explained the PhilHealth member is affected because instead of the hospital giving higher benefits, it is slashed down out of the facility’s fear of being left unpaid. He urged patients who experienced downcasing to report to PhilHealth, so that necessary actions, like filing of cases or calling the attention of the facility, may be implemented.
Dennis Andre, PhilHealth vice president for regional office 1, pointed out that downcasing may be also treated as fraud. He said this should be reported to the state insurer, “especially if the hospital involved has filed a claim with a higher case rate than what was deducted to the patient.”
PhilHealth executive vice president and chief operating officer Eli Dino Santos said cases may be filed against health providers “for under deducting the benefits of a member and claiming a larger amount as claims by the provider.”
CNN Philippines’ Xianne Arcangel contributed to this report.
