Some HCIs pay people to pass off as patients to defraud PhilHealth

MANILA, Philippines — Some healthcare institutions (HCIs) are allegedly paying individuals P1,000 each for them to act as patients in order to claim reimbursement for more serious diseases from the Philippine Health Insurance Corporation (PhilHealth), Senate Majority Leader Juan Miguel Zubiri disclosed on Tuesday.

Zubiri said this as he revealed more alleged schemes at PhilHealth during a Senate hearing on alleged irregularities in the state insurance firm.

“Some HCIs—this is a true story told me by one of those who are in PhilHealth as one of the investigators—they pay people P1,000 to act as patients in order to claim for more serious ailments from PhilHealth,” the senator said.

According to the senator, some provincial primary hospitals were once inspected by surprise by investigators from PhilHealth. However, the investigators found that the patients were not in the hospitals by checking the logbook and inspecting the rooms and beds where they were supposed to be admitted.

“When asked, the hospital staff would say that they will call the patients. The patients would arrive and lay back in bed. When asked where they came from, ang sagot nila nagpakain lang sila ng baboy (they will say they fed the pigs) and other excuses,” he added.

Aside from this, Zubiri also said that some HCIs give patients Losartan medicines for hypertension then claim the case rate as mild stroke and charge PhilHealth as much as P25,000 per claim. He described this  as a “clear case of upcasing.”

Some HCIs also allegedly have three to four ghost patients, whose claims earn as high as P100,000 a week.

“Pagnanakaw talaga ito (This is clearly stealing). This is no other than blatant fraud and corruption which is utilizing the funds and money that should go to proper patients,” said Zubiri.

The lawmaker also disclosed that other HCIs also allegedly give paracetamol to patients and send them home but would charge PhilHealth for rooms and medicines under the patients’ name, and come up with a “fraudulent or made-up illness claim.”

In addition to Ospital ng Maynila that has yet to receive P19.3 million funds for PhilHealth’s Interim Reimbursement Mechanism (IRM), the senator said the state insurer has also yet to act on the IRM applications of at least two other government HCIs.

He said the Western Visayas Medical Center in Iloilo City has reported P121.4 million in unreleased IRM funds, while Corazon Locsin Montelibano Memorial Regional Hospital in Bacolod City is still waiting for the release of P41.7 million under the IRM.

IRM is an emergency cash advance measure of PhilHealth to provide hospitals with an emergency fund to respond to unanticipated events like natural disasters and calamities.

On Sunday, Zubiri also revealed that the Golingay General Hospital in Malalag, Davao Del Sur has received P18 million in claims in 2014, and almost P10 million in the first semester of 2015 despite being an 18-bed infirmary.

He blamed PhilHealth administration and its Legal Sector for the continued practice of these alleged schemes.

“Problem number one, orders from the Legal Sector to ignore court rulings on fraud. The Supreme Court and Court of Appeals’ final decisions on the suspension of hospitals have remained unimplemented or ignored by PhilHealth,” Zubiri added. [ac]

RELATED STORIES

PhilHealth official says IRM ‘not pocketed by anyone’
P3B in funds released by PhilHealth weekly ‘exposed to corruption’ — PACC
Ex-PhilHealth officer: Regional Office II wrongly credited P9M to Bataan rural bank