Hontiveros to submit a bill to protect PhilHealth from false claims

false claim

A bill to safeguard the Philippine Health Insurance Corporation from fake claims and overpayments is set to be submitted in the Senate.

Senator Risa Hontiveros said on Wednesday that the suggested PhilHealth Insurance False Claims Act will prevent and minimize fraud despite the penalties provided for under Section 38 E(2) of Republic Act No. 11223 or the Universal Health Care Act (UHC).

Hontiveros said she intends to enhance the fraud detection processes of PhilHealth, including shifting from the present case rate payment to a diagnosis-related grouping provider payment system, and offering assistance to PhilHealth employees flagging anomalies.

She said that by implementing the UHC law, preventing, detecting and reporting fraud becomes an even more significant task that PhilHealth needs to tackle.

The senator said there is a need to revisit the penalty of suspending hospital operations and seriously consider imposing monetary penalties that are at least three times the amount of detected fraud.

Hontiveros stated that she was particularly alarmed by the report that PhilHealth continues to overpay fraudulent hospitals and clinics through “overstaying” or “ghost” patients, including WellMed Dialysis Center, whose accreditation was suspended for making false claims to PhilHealth for “ghost” dialysis patients.

She added that the seriousness and disturbing nature of these accusations should prompt a review of the anti-fraud systems of PhilHealth. Every peso lost to corruption in our health programs would imply that a citizen is deprived of life-saving medication or therapy. Corruption makes our individuals unhealthy and even threatens their life.

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