Metro Manila (CNN Philippines, August 18) — Officials of 45 hospitals with pending fraud cases were called to attend the next House probe on controversies surrounding the Philippine Health Insurance Corp.
Anakalusugan Partylist Rep. Mike Defensor said during the joint hearing of the House Committees on Public Accounts and on Good Government and Public Accountability that these hospitals have outstanding fraud cases from 2013 to 2018.
“We want to know the nature of the cases and understand how fraud is committed in PhilHealth,” Defensor said Tuesday.
“Fraud, to my mind, is committed with the hospitals. We have to understand how it is being done,” he added. “For example, sa pneumonia, dapat may x-ray. Paano kung may usapan and hindi na ini-require?”
[Translation: For example for a case of pneumonia, an x-ray must be conducted. What if there was a collusion and it was not required anymore?]
Among the hospitals mentioned were Abra Provincial Hospital, Baguio General Hospital, Divine Word Hospital, Butuan Doctors Hospitals and College Inc., and Quezon City Eye Center.
Defensor said not all of the hospitals to be summoned are part of the 51 health care institutions who had separate violations involving the interim reimbursement mechanism or the IRM, as mentioned in Monday’s hearing.
During that hearing, it was bared that hospitals with pending resolution on their cases had received a total of ₱1,493,554,124 from the IRM program.
The IRM, an emergency fund advanced to hospitals in case of “fortuitious events” such as floods and typhoons, was suspended last week due to numerous irregularities.
PhilHealth chief Ricardo Morales himself claimed that no healthcare system can ever be “fraud-free.” Hospitals may have also been colluding with patients to “upcase” simple health diagnosis such as cough or colds to more complicated illnesses to get funds from the agency, he reasoned.
The joint panel earlier bared overpayment and other fraudulent schemes in the agency have caused estimated losses of up to ₱153.7 billion in 2013 to 2018.
