PhilHealth: Caution vs. fraud causes delays in paying hospital bills

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Delays in the Philippine Health Insurance Corporation’s payment of some of its hospital obligations was due to a stringent system of ensuring that only valid claims would be paid, said PhilHealth official on Thursday.

PhilHealth CEO Ricardo Morales said that the state health insurer was cautious not to pay for fraudulent claims, such as the recent “ghost dialysis” dispute in which his employer WellMed Dialysis & Laboratory Center Corp. falsely accepted and gained from reports of deceased or “ghost” patients.

Some 600 hospitals reportedly threatened to forgo the renewal of their PhilHealth accreditation in 2020 due to unpaid claims of billions of pesos.

According to him, as of August of this year, PhilHealth had already paid some EUR 75 million in claims, adding that this year the state health insurer has provided a budget to strengthen its interconnection network for the processing of claims.

He also noted that some doctors had already been suspended due to corrupt activity.

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