Amid reports of fraudulent claims from doctors and hospitals, the state-run Philippine Health Insurance Corp. (PhilHealth) was closely looking into its funds and the possibility of channeling a big chunk of it into preventive care and checkup packages.
“We have to lessen the scams and the bleeding so we can spend for what we really need,” said Dr. Minguita Padilla, head executive staff of the Department of Health (DOH). The agency has been consulting with the Philippine College of Physicians (PCP) on how to put parameters in monitoring and detecting fraud in PhilHealth claims, she added.
The DOH and PhilHealth recently discovered fraudulent insurance claims on pneumonia treatments, prompting them to stop payments to at least two hospitals.
Padilla said PhilHealth was also set to roll out its “Tsekap package,” an expanded program covering the medical checkup of indigent PhilHealth members to prevent diseases. The program will be funded from the P37-billion subsidy that PhilHealth gets from sin tax revenues collected annually.
Z packages
PhilHealth increased as well the number of hospitals accredited to avail themselves of Z packages, the coverage for catastrophic illnesses.
“We have an annual budget of P1 billion for that, but only
P100 million was used in a year,” Padilla said, adding that more hospitals have been availing themselves of the Z package.
Dr. Tony Leachon, PCP president, meanwhile, proposed a strong audit and control system within PhilHealth so that erring doctors could be penalized by the Philippine Regulatory Commission.
Collusion thrives
“For as long as the regulatory, justice and penal systems are weak and unpredictable, and the internal controls are leaky and static, collusion will thrive,” he said.
PhilHealth employees colluding with erring doctors and hospitals deserve harsher penalties, the PCP official added.
At least four healthcare institutions were being investigated by PhilHealth and the DOH over questionable claims that have allegedly doubled over the last two years.
The Senate had likewise begun its investigation into reportedly suspicious claims by hospitals and clinics that had amounted to P2 billion.
Pneumonia cases up by 28%
Padilla noted that for pneumonia cases, the benefit payments in 2015 had soared by 28 percent, from P56 billion to P78 billion.
Several hospitals were admitting patients with simple cough and other respiratory illnesses and declaring the cases pneumonia, she said.
“If you are admitting a patient for a night or two days, that’s not pneumonia,” Padilla said.