Harsher law needed to prevent PhilHealth claims fraud – Guingona

MANILA, Philippines – Senator Teofisto Guingona III on Wednesday, July 1, said new, stricter law with harsher penalties should be passed to go after syndicates which defraud the Philippine Health Insurance Corporation (PhilHealth) through fake or bloated claims.

The Senate blue ribbon committee, which he chairs, heard on Wednesday the testimony of PhilHealth officials, who had uncovered that at least 6 health care facilities tricked PhilHealth members to undergo cataract surgery even without the patients' informed consent.

The doctors and clinics in turn were able to make too many claims with PhilHealth while endangering the patients. The agents who brought in the patients got commissions from these doctors and facilities.

Removal of cataracts ranked 4th among the top conditions and procedures PhilHealth paid for in 2014. This is equivalent to P3.7 billion out of the P78-billion total benefit payments that year.

Health insurance officials called for stronger deterrents and criminal penalties against health insurance fraud.

PhilHealth President Alex Padilla said insurance fraud is not an isolated problem in the Philippines but a worldwide "epidemic of greed."

Guingona said a new law with "more teeth" would help address the problem.

"Mas importante dito 'yung paggawa ng bagong batas para 'di na mangyari 'yung nangyari. Klaro naman sa ating lahat kung gaano kabigat itong mga bintang na 'to, at dapat hindi na mangyari sa ating mga kapwa Pilipino, at dapat pangalagaan natin ang pera natin sa PhilHealth," the committee chair told reporters in an interview.

(It's more important to craft a new law to prevent more incidents like this from happening. It's clear to all of us how grave the allegations are, and this should not happen to Filipinos, and we should protect PhilHealth funds.)

'Partnerships with doctors, facilities'

Guingona said there is basis to believe a syndicate is behind this "scam."

"Ang nangyayari ngayon, mayroong mga umiikot, 'yung tinatawag na seeker o naghahakot ng tao, lalong-lalo na 'yung mga mukhang senior citizens. Sinasabi na kailangang magpa-checkup ka ng mata, at sasabihin pa nga, kailangang magpalinis ka ng mata, pero pagbalik nila naoperahan na pala sila, para lang makakolekta 'yung doktor ng bayad sa PhilHealth," he said.

(What is happening now is that "seekers" go around to bring patients, especially senior citizens, to clinics. They tell patients to have their eyes checked up or cleaned, but patients find out later on they already went through cataract surgery so that doctors can collect payments from PhilHealth.)

The senator added, "Parang may partnerships nga: partnerships with doctors – unscrupulous doctors – and partnerships with some facilities." (There really seems to be partnerships: partnerships with doctors – unscrupulous doctors – and partnerships with some facilities.)

For the next hearing on July 8, the committee will invite doctors who allegedly connived with the "seekers" so they can defend themselves and air their side. – Rappler.com

Jee Y. Geronimo

Jee is part of Rappler's Central Desk, handling most of the world, science, and environment stories on the site. She enjoys listening to podcasts and K-pop, watching Asian dramas, and running long distances. She hopes to visit Israel someday to retrace the steps of her Savior.

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