News
PhilHealth allays fears on fund losses due to fraud - May 31, 2007
The Philippine Health Insurance Corporation today assured its members and stakeholders that it is financially stable and that losses due to fraudulent claims are left to the barest minimum.
Atty. Valentin C. Guanio, OIC of the Office of the Acting President and CEO today clarified recent press reports that PhilHealth is losing about 4 billion pesos to alleged fraudulent claims, saying that the incidence of fraud and the resulting financial losses can not be established yet. "There really are no hard figures yet on the alleged losses but we would like to assure the public that these are contained and will not in any way affect PhilHealth payments to its members and providers." Guanio said. He said that PhilHealth remains to be financially stable with a net income of P9.1 billion in December 2006 based on the year-end financial statements. PhilHealth also has 62.1 billion pesos investment portfolio in highly marketable government securities as of December 31, 2006. It has a very sound cashflow and liquidity is assured to pay benefit claims and other necessary funding requirements.
Guanio stressed that these fraudulent claims are committed by very few unscrupulous and inconsiderate bad eggs among the many upright and honest hospitals and doctors. "We are very well aware of such activities that's why we have instituted stringent measures to curb such malpractices." he added. PhilHealth is revoking the accreditation of doctors and hospitals found guilty of fraudulent activities. "We make sure that any activity that will defraud the program of precious pesos are dealt with in accordance with PhilHealth's quasi-judicial powers." he added.
Aside from revoking the accreditation of erring doctors and hospitals, PhilHealth has created a Fact Finding and Administrative Investigation Department (FFAID), an anti-fraud department that does hospital inspection and monitoring of claims. Furthermore, a Peer Review Committee (PeRC) was tasked to serve as an expert panel in resolving issues regarding quality of practice composed of members from PMA, PHA, PRC and major medical societies. Health Technology Assessment Committee was also created to ensure medicines and devices claimed by doctors and hospitals were with proven scientific evidence, safety and cost effectiveness. PhilHealth has also tapped the NBI and the PNP to aid in the investigation of reports of fraudulent activities. "In fact, for 2006 we have prosecuted 425 cases and have elevated to the health insurance arbiter some 181 cases related to fraudulent claims. We are currently investigating 217 more cases of the same nature." These are on top of PhilHealth's continuing efforts at closely working with its stakeholders in the health sector and heightening member awareness on fraudulent activities.
From January to March this year, PhilHealth has paid about 4.8 billion pesos in hospitalization benefits to its members and the amount is expected to reach 9.64 billion by the end of the first semester. These amounts represent an average value paid per claim of about 6,200 pesos, which translates to about 74 percent of the member's hospital bill in ward accommodation in both government and private hospitals.
"PhilHealth members have nothing to worry about as far as their contributions to PhilHealth are concerned. We are doing our best to safeguard their premiums as the administrator of the National Health Insurance Program." Guanio said.