DOJ: ‘Fraudulent schemes’ inside PhilHealth done in collusion with doctors, banks

MANILA, Philippines — Two resource persons, who were formerly connected with the Philippine Health Insurance Corporation (PhilHealth), have exposed alleged “fraudulent schemes” inside the agency, which were conducted by its employees and officials, in collusion with doctors and hospitals, and even banks.

This was what the Department of Justice (DOJ) had reported as Task Force PhilHealth held its first investigative hearing on the alleged anomalies inside the state health insurer on Friday.

“The individuals (who requested anonymity) informed the Task Force of the different fraudulent schemes allegedly employed through the years by PhilHealth officers and employees, both at its main office and regional offices, in collusion with some doctors and hospitals, and even banks which act as remittance centers,” DOJ Undersecretary and spokesman Markk Perete said in a statement on Saturday.

Such schemes include the payment of false or fraudulent claims against PhilHealth, the malversation of premiums, as well as the exploitation of “some unscrupulous personalities” of the case rate system and the interim reimbursement mechanism, among others.

The resource persons, Perete added, also exposed the “abuses and flaws” in PhilHealth’s legal department and information technology (IT) office which allegedly made the proliferation of the schemes possible.

Task Force PhilHealth is headed by Justice Secretary Menardo Guevarra, with the Office of the Ombudsman, the Commission on Audit, the Civil Service Commission, the Presidential Anti-Corruption Commission, the Office of the Special Assistant to the President, the Anti-Money Laundering Council, the National Bureau of Investigation and the National Prosecution Service as members.

The task force created on orders by President Rodrigo Duterte is tasked to look into allegations of widespread corruption within PhilHealth.

/MUF