Members of the so-called “mafia” in the Philippine Health Insurance Corporation are allegedly conniving with private health care institutions to defraud the state insurer of millions of funds.Senate Majority Leader Juan Miguel Zubiri bared this Wednesday as he cited insider information that the group was involved in the alleged anomalous transactions concerning the state-run insurance firm.
The schemes include the claims being made by some unscrupulous HCIs for their treatment of patients who are either deceased or non-existent; and the alleged upcasing and fabrication of illnesses to charge the health insurer of heftier claims. “If you notice, ‘yong bayaran, usually opisyal lang ng Philhealth at may-ari ang nakikipag-usap eh . So pag sinabi ng may-ari na ‘Huwag kang mag-alala, meron ka dyan’, wala na, delikado na ,” he added.
Pls look at several scenarios here. 1. When the hospital is UPCASING the cases for its Philhealth claims 2. When the hospital is forced to SETTLE its denied claims the regional or national offices 3. When the hospital and Philhealth officials connive to milk it of its funds
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