PhilHealth steps up campaign vs fraud

MANILA, Philippines — Preparing for the implementation of the Universal Health Care (UHC) law, the Philippine Health Insurance Corp. (PhilHealth) has intensified its campaign against fraud.

In a statement, PhilHealth acting president and chief executive officer Roy Ferrer said they are working with government agencies to stop irregular practices by accredited healthcare facilities and health professionals.

“We cannot afford to fall short on our efforts to halt the progression of these deceitful practices, especially now that the National Health Insurance Program needs a strong and stable fund to enforce the (UHC law),” Ferrer noted.

Ferrer added that PhilHealth recently signed a memorandum of agreement with the National Bureau of Investigation to strengthen their efforts against fraud. 

Ferrer said PhilHealth has “castigated” 71 hospitals across the country due to breach in accreditation, misconduct and other grounds.

PhilHealth also entered into an agreement with the Philippine Medical Association and Philippine Hospital Association to “confront erring health care institutions,” while the Professional Regulation Commission was tapped to sanction dishonest health professionals.

Last year, PhilHealth filed about 5,000 cases with its prosecution department against health care institutions and professionals. 

The agency takes 17 days to process a case build-up.

The fraudulent transactions include recruitment of members to bogus wellness programs and filing of claims for deceased patients. 

P4.5 billion for PWDs

Around P4.5 billion may be needed annually to enroll 1.9 million people with disability (PWDs) in PhilHealth, an official said yesterday.

In an interview, PhilHealth corporate communication department senior manager Rey Baleña noted that the budget for coverage of PWDs was based on the 2010 Census of Population and Housing.

The census showed that of the 92.1 million household population in 2010, a total of 1.44 million have disabilities.  In the 2000 census, the number of PWDs was 935,561, indicating a difference of around 500,000.

“Given this, the number of PWDs may be almost two million or around 1.9 million next year. So if the premium payment is P2,400 annually, we will need P4.5 billion for PWDs,” Baleña said.

But Baleña said there are PWDs who could cross categories.

“The PWDs in the formal sector… their premium contributions are shared equally by their employers and the national government. They do not pay for it. And another reality is that there are indigent members who could also be PWDs,” he added.

Baleña assured the public that PhilHealth has a system of preventing “double coverage” among members.