DOH, PhilHealth to probe dialysis centers for fraud

After discovering questionable claims for cataract surgeries filed by two eye centers last year, the Department of Health (DOH) and the state-owned Philippine Health Insurance Corp. (PhilHealth) have turned their attention on dialysis centers with bloated claims.

Health Secretary Janette Garin said the investigation by a PhilHealth task force will include dialysis centers that have registered an unusual increase in insurance claims over the last two years.

“In the coming months, other cases of possible fraud will start coming in and we are looking into the possibility of checking dialysis centers,” Garin told reporters in a recent press briefing.

She said that an audit of the P78 billion that PhilHealth paid to affiliated healthcare institutions in 2014 showed a suspicious spike in hemodialysis treatments for kidney patients.

“The audit is still ongoing and our team has seen an increasing trend in the coverage of dialysis sessions. The intention now is to bring it down,” said Garin.

She said it was important that the fraudulent claims were stemmed to allow PhilHealth to expand its dialysis coverage for kidney patients.

Instead of insurance funds going to spurious claims, PhilHealth could pay for more dialysis sessions for its beneficiaries, she said.

“If we curb that, there is a chance for us to widen the coverage of hemodialysis treatment for our patients,” she said.

Garin said that PhilHealth was set to mark down its rate for hemodialysis from P4,000 per session to P2,500 in order to allow patients to have more sessions, from 45 to 72 a year.

She said P2,500 was enough to cover treatment, the doctor’s or healthcare worker’s professional fee and payment to the healthcare institution.

Earlier, PhilHealth president Alex Padilla announced the suspension of payments to two eye centers in Makati and Quezon City pending a thorough validation of their claims, particularly for cataract surgeries.–Jocelyn R. Uy