3 health facilities in Mindanao charged for collecting higher bills from PhilHealth – Gierran

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Metro Manila (CNN Philippines, October 16) — Three private health facilities in Mindanao have been charged for filing PhilHealth reimbursements with amounts higher than what were really spent on patients.

PhilHealth president and chief executive officer Dante Gierran said the National Bureau of Investigation filed cases last week against three healthcare providers in Zamboanga del Norte, Koronadal City, and Davao del Norte.

"All these involve the very core of the alleged fraud committed against PhilHealth involving 'yung tinatawag nila na upcasing, upcoding, upbilling and the rest," Gierran told CNN Philippines' The Source, saying these are on top of the cases filed against PhilHealth officers for its Interim Reimbursement Mechanism scheme.

Upcasing and upcoding refer to the modus where a patient's diagnosis is changed to a more severe condition so that a facility can collect higher health insurance payments.

READ: 51 hospitals with fraud cases still got ₱1.49 B from PhilHealth — lawmaker

PhilHealth has been under fire in recent months after a whistleblower claimed that key officials behind a so-called mafia pocketed ₱15 billion from the agency through various illegal schemes. Last year, PhilHealth cases have been filed for irregular claims on "ghost" dialysis patients.

Other issues under investigation are the overpriced COVID-19 testing benefit packages, overpriced IT projects, and the health insurance agency's misplaced investments worth ₱866 million in common shares, even if PhilHealth is limited to making bets in preferred stocks only.

Gierran admitted that there are some 7,500 reports and cases of alleged fraud which are yet to be resolved by PhilHealth's central office.

RELATED: Task Force: PhilHealth execs negligent on IRM implementation, concealed info and documents

The new PhilHealth chief, a lawyer-accountant who once served as NBI director, admitted he has a lot on his plate as President Rodrigo Duterte gave him a December deadline to clean up the agency.

"That’s a very hard job. This reported alleged frauds existed a long, long time ago and this cost something like ₱150 billion according to the report of the COA," said Gierran, who only assumed the top post in the agency in September.

"If I can only create a dent on those alleged corruptions in PhilHealth, then I will be happy and go back to my hometown happy."

Apart from an internal cleansing drive, the Presidential Anti-Corruption Commission, the Office of the Ombudsman, and a Cabinet-level task force led by the Justice Department are probing PhilHealth anomalies.

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