Fake claims in Philhealth to be investigated

The Philippine Health Insurance Corporation (PhilHealth) is receiving more and more questionable charges from hospitals, so until the investigation is completed, nothing will be paid, which private hospitals complained of.

According to the PhilHealth investigation, they solved more than 15,000 false claims from various health facilities from 2019 to this year.

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Types of false claims:

  • Misrepresentation/false information
  • Ghost patients
  • False rating of claims
  • Fabricated forms & supporting documents
  • Adding of claims & spending period of confinement

Types of non-fraudulent claims:

  • Breach of warranties of accreditation
  • Multiple claims
  • Unauthorized operation beyond service capability
  • Unjustified admission beyond bed capacity

In effect, these claims will not be paid until the investigation has a final result.

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If found guilty, fine, suspension, or removal of PhilHealth accreditation is the penalty.

“Dapat tigil din tayo sa payments kasi public funds ‘tong dini-disburse natin di ba? Pera n’yo ‘to eh. Dapat mas diligent tayo in paying claims and disbursing these funds,” said PhilHealth spokesperson Shirley Domingo.

Fake claims in Philhealth to be investigated

But the Private Hospitals Association of the Philippines (PHAP) has a different view on PhilHealth’s justification.

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“Na-notice namin kasi, every time na hindi sila nakababayad sa mga hospital, ‘yan ang ginagawa nilang way of trying to intimidate the hospitals,” said PHAP president Jose de Grano.

“The truth is, gusto nilang i-cover up, ‘yung hindi nila pagbabayad for the past year sa mga hospitals. So ngayon pinapalabas nila na nandaraya ang mga private hospitals,” said De Grano.

PHAP has a challenge with PhilHealth.

“We do not go to illegal things… If they have proof, go ahead, give our hospitals due process and then they can file the cases,” said De Grano.

PhilHealth still owes more than P28 billion to private hospitals, De Grano said.

Because the payment is in arrears, many hospitals are said to be out of funds so if they do not close, people will be laid off.

Apart from appealing to the Supreme Court, PHAP also plans to seek the help of the Anti-Red Tape Authority.

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