News
PhilHealth, PAO Join Forces to Help Curb Abuses - February 15, 2008
The Philippine Health Insurance Corporation (PhilHealth) recently signed a Memorandum of Agreement with the Philippine Academy of Ophthalmology (PAO) to help curb abuses in the National Health Insurance Fund through fraudulent claims by erring doctors.
In PAO's recent Annual Meeting in Pasig City, Lorna O. Fajardo, Acting PhilHealth President and CEO and PAO President Dr. Dominga Padilla jointly denounced the practice of some health care providers performing cataract extractions beyond what is considered appropriate and ethical.
"These doctors engage the services of agents called 'seekers' who deliver a steady supply of patients, many of whom are PhilHealth members, to avail of huge reimbursements," said Fajardo, stressing that "..what is unfortunate here is that these patients are gathered and operated on under compromising conditions."
Patients treated by these eye doctors reportedly go under the knife under the worst operating conditions imaginable. They are reportedly gathered from different far-flung areas supposedly to benefit from a mass cataract operation in the guise of medical missions. "But in truth, they are just being used to defraud PhilHealth in the form of questionable claims. This is why we have taken measures to put a stop to this practice," said Fajardo.
Aside from providing PhilHealth with a list of PAO-sponsored cataract projects to help identify valid cataract claims for payment, the agreement also binds PAO to act on PhilHealth-referred cases and to actively participate in consultative meetings to be held once a month. "We are thanking PhilHealth for recognizing our authority and expertise in resolving a malpractice that involves some of our member-ophthalmologists," added Padilla.
The MOA with PAO, a specialty society, is a first in the history of PhilHealth and is unprecedented even during the entire existence of its predecessor, the Medicare Commission which spanned the early '70s to mid-90s.
"We are taking on the challenge as we have recognized the fact that these fly-by-night missions may have been indeed become breeding grounds for the unscrupulous conduct of a very few of our members," Padilla assured PhilHealth and the delegates during the ceremony. She added that "..through this MOA, PAO has concretized its continuing commitment and support to the ideals of PhilHealth." (END)