PhilHealth ‘mafia’ seen behind padded claims

A PhilHealth official, who requested anonymity for security reasons, said that every time someone new came in to head the state insurance company, a group of board members saw to it to bring to that person’s attention the need to review PhilHealth’s case rates and the payments made, which the Commission on Audit has repeatedly flagged over the years.

“We all know that we’re losing a lot of money. Why isn’t there anybody who’s in a position to do something about it not doing something?” said the official, who also requested not to be identified.One reason the “racket” persists, despite public pronouncements of accountability, is the existence of a “mafia” in PhilHealth, which “ensures that there’s no review of the rates and overpayments,” the official said.

Even doctors and hospitals, she said, would not dare come forward to talk about the shenanigans going on in PhilHealth out of fear that their accreditation will be removed, thus depriving them of patients. Padilla pointed out that even during her tenure of just over a year, she “tried” her best to help address the problems that beset PhilHealth.For one, she helped cleanse its system by bringing down the number of people authorized to have access to its database from more than 11,000 to around 3,500. Those who were stripped of the access were found to be no longer connected with PhilHealth, a potential security and data breach.

The danger with this is that, if a particular hospital made fraudulent claims in the past in cahoots with erring officials, the UHC fund “bleeds from the start,” Padilla said.With the huge amount involved in the UHC, Padilla said there was a need to create an interagency oversight body, which will help curb medical insurance fraud, similar to that in the United States.

Source: Healthcare Press (healthcarepress.net)

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