PhilHealth-12 probes alleged fraud in Covid-19 claims

The Philippine Health Insurance Corporation (PhilHealth) in Region 12 (Soccsksargen) has launched an investigation into the alleged fraudulent practices of several hospitals in the area involving benefit claims for the coronavirus disease 2019 (Covid-19).

Dr. Hector Zenon Leonardo Malate, acting regional vice president of PhilHealth-12, said Monday they are currently looking into the supposed manipulation of the cases of some patients admitted in various local hospitals to make them appear as Covid-19 cases.

Malate said he received reports on the fraudulent practices after being assigned in the region in October last year. He said they already have the names of some patients who were allegedly declared to have been admitted and treated for Covid-19 despite having non-related symptoms.

“These are now being validated and investigated by our legal unit,” he said in an interview.

Malate urged residents admitted to any hospital in the region in the previous months and whose cases were elevated to Covid-19 to increase their benefit claims to report the matter to the agency so they can also make an investigation.

As of end February, PhilHealth-12 already processed and reimbursed a total of 906 claims related to the disease out of the 5,789 submitted since last year by private and government facilities.

It covered Covid-19 patients admitted and treated in hospitals, those accommodated in community isolation units, and individuals who were required to undergo swab tests.

The released claims reached around PHP4 million. Two of the claims were under the full financial risk package for health workers.

Malate said they have been thoroughly evaluating the reimbursement claims related to Covid-19, and all of these are subjected to the stringent medical pre-payment review.

Under this process, hospitals must submit certified true copies of the patients' clinical charts, and these will undergo an assessment by the agency’s doctors.

As of Monday, he said the pending claims include 447 cases of pneumonia that were declared related to Covid-19, with 141 listed as mild, 165 moderate, 100 severe, and 41 critical.

“The benefit package for Covid-19 is quite big, so we’re cautious before making any payment. The claims should have attached confirmed or positive test results, and we return those that don’t have them to the hospitals,” he added.

Source: Philippines News Agency

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