80 hospitals in Eastern Visayas under probe for alleged fraud

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Tacloban City (CNN Philippines, February 26) – Eighty hospitals in Eastern Visayas are being investigated for alleged ghost claims, according to a regional official from the state health insurance firm.

Philippine Health Insurance Corporation Acting Regional Vice President Michael Jibson C. Hernandez said the medical facilities are under probe for supposedly claiming payments for nonexistent treatments, without giving detailed information.

Hernandez then warned that PhilHealth will temporarily stop paying the health care providers once they are found guilty of engaging in fraudulent activities. Aside from not releasing payments, PhilHealth may cancel their accreditation as well as face administrative and criminal charges.

Citing humanitarian considerations, the official said they cannot impose the sanctions right away especially if there is only one PhilHealth-accredited health care provider in a specific area.

“We need to balance, kasi may mga provider na sila lang ang nanduduon. Kung masyado tayong strikto, wala nang mapupuntahan 'yung mga pasyente natin, kawawa naman,” Hernandez said.

[Translation: We need to balance because if we will be too strict, our patients will be left with no health care provider.]

Meanwhile, a PhilHealth member who “knowingly and deliberately cooperates or agrees” to commit a wrongdoing with a hospital is at risk of having their insurance benefits suspended, being imprisoned from three to six months, and fined P50,000 for each count of fraud.

In Eastern Visayas, PhilHealth has more than 4 million members as of 2019.

Last year, PhilHealth has revoked the accreditation of dialysis center WellMed, which was alleged to have filed bogus claims with PhilHealth using names of dead dialysis patients. The alleged scam also involves PhilHealth officials who are facing graft complaints before the Justice Department.

The owner of the WellMed and its former employees, who exposed the dialysis center, has profited from fraudulent claims from the state health insurer. They were charged with estafa before a Quezon City court.

The court, however, dropped the charges against them, saying it has no jurisdiction over the case.