PhilHealth records around 10K cases of ‘upcasing,’ false claims
MANILA, Philippines — Philippine Health Insurance Corporation (PhilHealth) chief Ricardo Morales said the agency has so far recorded around 10,000 cases involving erring health institutions and medical professionals.
“Yung legal sector namin has about 10,000 cases involving hospitals and medical professionals, various cases, mga ‘upcasing,’ false claims. Marami yan e,” Morales said in an interview over dzMM Teleradyo on Thursday.
(Our legal sector is handling about 10,000 cases involving hospitals and medical professionals, various cases, like ‘upcasing,’ false claims. There’s a lot).
Upcasing of illnesses, for instance, happens when hospitals submit claims for pneumonia even if the patient may have had only a cough or a cold.
Morales did not elaborate further on the cases during the interview.
INQUIRER.net has reached out to Morales for more details but has yet to receive a response as of writing.
Article continues after this advertisementMeanwhile, Morales also addressed issues regarding PhilHealth’s unpaid claims to hospitals supposedly amounting to P18 billion.
Article continues after this advertisement“We don’t know where this is coming from. Iba yung sinasabi ng libro namin,” he said.
(We don’t know where this is coming from. Our records show otherwise).
Earlier, Cagayan de Oro 2nd District Rep. Rufus Rodriguez, through House Resolution No. 970, urged PhilHealth to settle the P18 billion unpaid claims of accredited hospitals in the country.
The resolution cited data from Philippine Hospitals Association of the Philippines, Inc. (PHAPi) which showed that PhilHealth allegedly owed its members P14 billion as of December 2018 and an additional P4 billion in 2019.
PHAPi is composed of 733 hospitals nationwide, with a total bed capacity of more than 44,700 beds.
Morales said he would have to reconcile the said amount with PhilHealth records.
“Kasi minsan hindi nagkakatugma [yung libro ng ospital at ng PhilHealth]. Ang sinasabi nila this is what we owe them, e ang alam naman namin, hindi naman,” he said.
(Sometimes the records of the hospitals and PhilHealth do not match. They would say we owe them this much, but based on our records, we don’t owe them that much).
According to the PhilHealth chief, the state health insurer pays a monthly average of P10 billion to 12 billion to hospitals.
He added that as of May this year, PhilHealth paid out around P70 billion to health institutions.
“P52 billion diyan sa regular benefit payment,” Morales said, adding that PhilHealth also gave out a cash advance worth P15 billion to 600 hospitals, which they can use for services and treatments related to COVID-19.
(P52 billion of the amount is for regular benefit payment)
“And then meron pa kaming ginawang accelerated na return to hospital account. Meron kasing sina-submit na claims yung mga hospital na ‘di kumpleto so nagiging return to hospital yun. So that’s about mga P4 to 5 billion. So ang total of almost P70 billion ang nilabas namin. The first five months of this year, that’s a lot of money,” he added.
(And then we also accelerated return to hospitals. There are times when hospitals do not submit all their claims so that becomes return to hospital. So that’s about P4 to 5 billion. So we paid out a total of almost P70 billion. The first five months of this year, that’s a lot of money).
