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DOH, PhilHealth urged to strengthen coordination to stop alleged fraudulent claims

Posted on July 8, 2015

By Jelly F. Musico

MANILA, July 8 (PNA) – Senator Teofisto ‘TG’ Guingona III, chairman of the Senate Blue Ribbon Committee, urged the Department of Health and the Philippine Health Insurance Corp. (PhilHealth) on Wednesday to strengthen coordination to stop the alleged fraudulent claims by some health care institutions from PhilHealth.

”Are these two agencies talking to each other? Or do we have to review their coordination because PhilHealth pays (claims) while DOH gives and revokes licenses. So, these two have to coordinate more,” Guingona said after the Senate inquiry into the alleged scam involving excessive payments on ghost or questionable treatments.

On the part of the Senate, Guingona said he is contemplating of legislating a new law that will improve the process of PhilHealth claims.

Guingona said he found probable criminal liability, “but again, these hearings are not crime proceedings.”

”If there are any criminal liabilities, the specialty associations, in this case the PAO (Public Attorney’s Office) will file the necessary cases. In fact I understand PhilHealth will also file the necessary criminal cases, but again the crime cases have to be proved in court and decided by the courts, not by the blue ribbon committee,” Guingona stressed.

Guingona is also looking on recommending the filing of plunder charges to stop the malpractices by some health clinics allegedly in connivance with some PhilHealth officials.

Meanwhile, Senate President Pro Tempore Ralph Recto urged PhilHealth to probe deeper into the fraudulent payments it made to private clinics and hospitals to find out if recipients of multimillion-peso reimbursements had help from the inside.

Recto also called for heavier penalties on those who pad or invent insurance claims, whether they are health professionals, institutions, state workers or employees of PhilHealth themselves.

Recto prodded PhilHealth officials to conduct an internal investigation.

PhilHealth President and CEO Alexander Padilla said the investigation they had done so far showed no collusion from within the agency.

“We followed the money and all the money went to private health care institutions,” Padilla said.

To dispel all doubts, Recto said the Commission on Audit (COA) must review some of the claims.

Upon questioning by Recto, the PhilHealth CEO said that most of the erring parties were private health care providers.

Recto said PhilHealth should likewise divulge the government hospitals which tried to pull a fast one on the state health insurer.

Recto noted that two-thirds of PhilHealth reimbursements went to the private sector “and it seems that claims applied for by them were acted somewhat expeditiously by PhilHealth.”

Recto said he also noted that payouts involving indigents, at PhP25 billion last year, was smaller than the PhP37 billion that government shelled out in premium cost for indigents it enrolled in PhilHealth during the same year.

On this, he urged Padilla to step up PhilHealth’s information campaign “so those who are covered but don’t know they are would be informed that they have medical insurance.” (PNA)

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