PhilHealth profiling accredited health providers

MANILA, Philippines — The Philippine Health Insurance Corp. (PhilHealth) is profiling all accredited health providers to identify those that commit acts of fraud, according to an official of the state health insurer.

At a press conference organized by the Department of Health yesterday, PhilHealth vice president Oscar Abadu Jr. noted that the profiling was initiated by PhilHealth president and chief executive officer (CEO) Dante Gierran “to see whether there are red flags in these providers.”

Abadu explained that Gierran wants to know “if there are individuals, doctors or health care institutions committing acts of fraud.”

“These are the clear plans of the new president and CEO… (his) first steps… to reorganize the organization and try to address the concerns, especially on the issues of irregularities/corruption and, of course, fraud committed by hospitals,” Abadu said.

He added that Gierran has partnered with the National Bureau of Investigation and Presidential Anti-Corruption Commission for the investigation of all cases recommended by both the Senate, the House of Representatives, including the directive of President Duterte.

The PhilHealth chief is planning to continue with the information technology (IT) program, according to Abadu.

Before doing this, however, he claimed that Gierran is looking at the processes and systems first to determine “where the possible gaps are.”

“Because everything should start with the current process, the systems and where the gaps are, loopholes that need to be addressed so that proper IT solutions shall be provided,” Abadu said.

He added that PhilHealth is in need of an IT system, which is the “key to identify all acts of irregularities, where corruption happens and possible acts of fraud will happen.”

Over 15 M still unregistered

Meanwhile, more than 15 million Filipinos are still not enrolled in PhilHealth, according to Abadu.

Abadu said 94.9 million or 86.1 percent of the country’s population are now members of the state insurer as of last September, while a total of 15.2 million others are still unregistered.

Under the Universal Health Care law, however, all Filipinos should automatically be covered by PhilHealth, according to Abadu.

The country’s current population is pegged at 110.9 million.

“Under Section 5 of the law, all Filipinos should be covered… Also, what we are aiming to achieve in the next few months is that each and every Filipino is registered with a primary care provider,” he said.