PhilHealth figures grossly bloated, says eye clinic

The government health insurance firm Philippine Health Insurance Corp. (PhilHealth) bloated the claims of some eye clinics for cataract surgery procedures to mislead the public, the owner of the Quezon City Eye Center (QCEC) said on Thursday.

Speaking to the media before the start of the hearing of the Senate blue ribbon committee on the alleged padded claims by some doctors and eye clinics, Dr. Raymond Evangelista said he has documents to prove that PhilHealth’s figures are “grossly inaccurate.”

“I am willing to submit all our financial documents, including our records of payments to the Bureau of Internal Revenue (BIR), showing the actual amount of our claims and what we have actually received from PhilHealth,” Evangelista said.

“There is a discrepancy of almost P46 million between what PhilHealth says we have received and what our records show,” he said. “There is definitely something wrong with their figures, and we don’t know if the padding of the amounts is deliberate on part of some PhilHealth insiders.”

The QCEC is one of two eye clinics which PhilHealth said are under investigation for “highly suspicious” benefit payments. PhilHealth said the claims of QCEC increased from P92.5 million (9,375 claims) in 2013 to P156 million (10,944 claims) last year.

“PhilHealth submitted bloated figures to the Senate; we can easily prove this based on what we paid to the BIR,” he said.

“As far as I know, the figures presented by PhilHealth to the Senate hearings for another eye center, Pacific Eye Center, is also bloated by P62 million,” Evangelista said during an interview and in a press statement..

“What we are concerned about is the plight of thousands of cataract patients, many of them senior citizens who are automatically covered by PhilHealth, who will now have to find other eye clinics and capable facilities to avail (themselves) of the free cataract surgeries which are their benefits as PhilHealth members.”

This is because eye clinics like QCEC have no choice but to stop catering to PhilHealth members because of PhilHealth’s decision to withhold payments to them without any due process, Evangelista added.

He said he does not understand why PhilHealth is singling out eye clinics, which charge the minimum P16,000 per cataract procedure as mandated by PhilHealth, when there are bigger hospitals that are performing similar surgeries but are charging so much more.

He also said the plan of PhilHealth and the Department of Health to limit the number of patients that eye doctors can operate on will result in ophthalmologists being selective, leaving the poorer cataract sufferers in the dark.