PhilHealth to probe fraud in benefit claims

CEBU, Philippines —  The Philippine Health Insurance Corporation (PhilHealth) is looking into allegations that some healthcare providers are colluding with patients to defraud the government insurance agency by upgrading ordinary respiratory cases to coronavirus disease (COVID-19) to collect higher benefits.

In a statement, PhilHealth appealed to everyone in possession of credible information on the unethical acts to report directly to the agency with the evidence they have for swift action. According to Philhealth, protecting the agency’s fund is a shared responsibility of every member.

The state insurer made the call following the proliferation on social media of video posts supposedly relating to incidents of health care providers conspiring with patients to declare minor respiratory illnesses like asthma as COVID-19 to claim higher benefits.

According to Philhealth, the practice is called “upcasing,” a form of health insurance fraud punishable with a fine of P200,000 or a suspension of contract of up to three years of the healthcare provider or both.

“It also constitutes a criminal violation punishable by imprisonment for 6 months and 1 day up to 6 years upon the discretion of the court in accordance to Section 38 of the Universal Health Care Law,” PhilHealth said.

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

However, PhilHealth warned those who post such information on social media without any proof to support their claims of possible legal problem for maligning the reputation of the healthcare facilities and healthcare professionals.

“They instead malign and compromise the reputation of hospitals, doctors and even the agency itself, acts that may lead to legal actions such as cyberlibel and violation of Article 154 of the Penal Code criminalizing publication of fakse information that may endanger the public order or cause damage to the interest or credit of the State,” PhilHealth said.

Concerned citizens and whistleblowers are encouraged to report frauds through face-to-face meetings at the nearest PhilHealth offices or email it to [email protected]; [email protected]; [email protected] .

PhilHealth assured that whistleblowers will be protected and given possible assistance as provided for by law. It also assured that the report will be treated with utmost confidentiality. — Caecent No-ot Magsumbol, FPL (FREEMAN)