Philhealth’s free cataract surgeries for poor, elderly continue despite probe on dubious claims

The Philippine Health Insurance Corp. (PhilHealth) said on Wednesday that Filipinos, especially the poor and the elderly, could still enjoy free cataract surgeries despite an ongoing investigation on some private eye clinics for dubious claims.

Dr. Israel Francis Pargas, the PhilHealth spokesperson, said the insurance company has not suspended its cataract surgery packages. “We only stopped the processing of payments of those clinics, which we have been investigating,” Pargas told the Philippine Daily Inquirer on Wednesday.

He said that two eye centers have been placed under investigation for suspicious claims for cataract surgeries.

A senior citizens group issued a statement on Tuesday, denouncing PhilHealth’s supposed “unilateral decision” to scrap the benefit package for cataract surgeries. The Senior Citizens Party-list said such move was tantamount to letting many Filipinos, including senior citizens, go blind.

“PhilHealth’s decision to stop processing payments to eye clinics for cataract operations that have been performed due to alleged irregularities is very suspicious and is very detrimental especially to senior citizens, many of whom suffer from cataract,” said the group’s legal counsel Hernan Nicdao.

“Now, PhilHealth is saying that it will not pay private eye clinics because of alleged irregularities. I think the real irregularity is PhilHealth’s cruel decision to leave cataract patients in the dark, with nowhere to go,” he added.

But Pargas explained on Wednesday that PhilHealth continued to pay accredited private eye clinics that were not being investigated for cataract surgeries under its special benefit packages.

In an earlier interview, PhilHealth president Alex Padilla said Philhealth members could easily avail of the special package in other accredited eye clinics in the country.

Padilla had identified the two eye clinics under investigation as Pacific Eye Institute and Quezon City Eye Center. The investigation was prompted after their claims supposedly jumped by more then 100 percent last year.

PhilHealth records showed that Pacific Eye Institute’s claims increased by 143 percent from 7,333 claims worth P69.58 million in 2013 to 11,635 claims worth P169.49 million in 2014 while the claims of Quezon City Eye Center surged from P92.5 million (9,375 claims) in 2013 to P156 million (10,944 claims) last year.