A group of doctors on Sunday urged the Professional Regulation Commission (PRC) to penalize erring physicians allegedly engaged in defrauding the Philippine Health Insurance Corp. (PhilHealth) through false reimbursement claims.
Dr. Anthony Leachon, president of the Philippine College of Physicians Foundation, also batted for improved mechanisms within the state insurance firm that would effectively monitor the benefits and claims of PhilHealth members.
“The case of erring doctors has to be addressed as soon as possible. Fraud of this nature is a group crime. For as long as regulatory, justice and penal systems are weak and unpredictable, and the internal controls are leaky and static, collusion will thrive,” said Leachon.
An internal audit of the Department of Health’s and PhilHealth’s P78-billion payout last year to accredited hospitals and healthcare providers prompted an investigation into some questionable claims made by some doctors and clinics.
Earlier, Health Secretary Janette Garin and PhilHealth president Alex Padilla said they were looking into P2 billion worth of claims filed last year for fraud, including P325 million worth of “highly suspicious” benefit payments for cataract surgeries issued to two eye clinics in Metro Manila.
The Senate blue ribbon committee also started its own investigation into the matter.
Leachon said the PRC must step in to punish erring doctors and revoke their licenses.
“It should not happen with just a deviant eye medical doctor… The regulatory agency should proactively flex its big muscles to preserve the integrity of the profession,” he said.
In improving mechanisms within the PhilHealth system, Leachon said the group was proposing the comprehensive computerization and building of information technology infrastructure to monitor the benefits and claims of PhilHealth members and affiliated healthcare providers.
“We need to rebuild PhilHealth to make it more relevant to the needs of Filipinos. With the huge sin tax funds added to [its] coffers, we deserve a better system,” he said, adding that the sin tax law will be a “total waste” if the earmarked funds to health will not be managed and spent well.
Last year, the state insurance firm received P35 billion in sin taxes, covering premium payments of 14.7 million poor families.
Lawmakers have also criticized PhilHealth for failing to conduct a thorough investigation into eye care centers involved in fraudulent insurance claims.
Gabriela Rep. Luzviminda Ilagan and Abakada Rep. Jonathan de la Cruz said that in its desire to make up for the massive fraud claims that blew up in its face, PhilHealth made sweeping accusations against eye doctors and eye clinics as being responsible for the scam.–Jocelyn R. Uy and Gil Cabacungan