State insurer Philippine Health Insurance Corp. (PhilHealth) said Thursday it was looking into instances of “upcasing” committed by hospitals and healthcare providers amid the COVID-19 pandemic.
PhilHealth spokesperson Shirley Domingo said upcasing happens when a person confined in a hospital is tagged as a COVID-19 case to get larger reimbursements from the state health insurer.
“Sometimes it’s just cough and cold and yet they report it as COVID to get higher reimbursements from PhilHealth,” she said in a television interview.
Domingo said PhilHealth’s legal division was already looking into reported cases of upcasing.
Domingo said the hospitals would be given due process during the investigation.
“There is a process, the hospital will be asked to explain, there is a hearing,” she said.
If proven that the hospital or healthcare provider committed upcasing, its PhilHealth accreditation could be revoked or suspended, she warned.
“It will depend on the decision of our legal division,” said Domingo.
