PhilHealth bares 9,200 fraud cases

posted March 14, 2021 at 11:50 pm
by  Manila Standard
The Philippine Health Insurance Corporation uncovered 9,200 cases of fraud in 2020 and another 325 in January 2021.

Cases olved breach of warranties of accreditation, misrepresentation of claims, among others, Corporate Communications Manager Rey Baleña said on Sunday.

In 2020, Philhealth’s investigating body received nearly 9,200 cases under investigation from regional offices, Baleña said in an interview over the radio.

PhilHealth hassigned an accord with the National Bureau of Investigation ( ) to combat fraudulent health insurance schemes.

PhilHealth signed a memorandum of agreement with the NBI to go after “illicit activities that are potentially defrauding the National Health Insurance Program.”

Both agencies agreed on a shared set of responsibilities to detect, deter, and prosecute fraud committed by health care facilities and professionals, and even those made in collusion with its own officers and employees.

Under the agreement, PhilHealth may request for investigative assistance from the NBI including surveillance, investigation, and entrapment of violators, if needed.

PhilHealth said that 95% of the ₱15-billion allegedlylost to fraud has been liquidated.

PhilHealth said a total of ₱14.21-billion Interim Reimbursement Mechanism or IRM funds have already been accounted for. The money went to 711 hospitals nationwide for their COVID-19 response.

Of the 711 hospitals, 516 have been fully settled, 153 have liquidated at least 50%, while 42 have only declared below 50% of their share so far.

PhilHealth data showed Metro Manila hospitals have liquidated over ₱4.1 billion, followed by CALABARZON or Region 4-A with about ₱1.14 billion.

PhilHealth President Dante Gierran said the liquidation of the ₱15-billion fund allegedly lost to corruption is expected to be completed within the first quarter of this year.

Topics: Philippine Health Insurance Corporation , PhilHealth , fraudulent health insurance
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