PhilHealth: Some doctors, hospitals involved in fraud

MANILA, Philippines — The Philippine Health Insurance Corporation (PhilHealth) admitted on Monday that a number of physicians and hospitals are indeed involved in fraudulent schemes and transactions with the state health insurer as earlier revealed by the task force investigating the agency.

Photo from Radyo Inquirer

“As to doctors and hospitals, totoo po ‘yun, nilalabas na namin for these past years,” said PhilHealth spokesperson Dr. Shirley Domingo in an interview on ABS-CBN Teleradyo.

(As to doctors and hospitals, that is true. We have been exposing that for these past years.)

“Meron po talaga. May mga nahuli na kami,” she said, adding that cases have been filed against involved individuals.

(They really exist. We have caught some of them.)

“But meron kaming employees in the past na committing fraud talaga. Kinasuhan namin sila at tinanggal namin sila. So hindi kami nagsasabing 100 percent wala. Meron,” she added.

(But we had employees in the past who committed fraud. We filed cases against them and fired them. So we are not saying that 100 percent we do not have corrupt employees.)

The government’s Task Force PhilHealth said Saturday that two individuals formerly connected with the agency have tagged hospitals, physicians and banks in fraudulent schemes over the past several years.

Department of Justice Undersecretary and spokesperson Markk Perete said the schemes include the payment of false claims, malversation of premiums, and the exploitation of the case rate system and the interim reimbursement mechanism, among others.

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