PhilHealth probes fraudulent claims

THE Philippine Health Insurance Corporation (PhilHealth) Region 1 office has launched an investigation of nine employees for alleged fraudulent claims and administrative lapses.

Dr. Leo Douglas Cardona Jr., the newly assigned regional vice president in Region 1 confirmed the reassignment of nine employees including Elvira Ver, former RVP of Region 1to the Office of the Chief Operating Officer starting November 18 to give way to the internal investigation.

“The reassignment is a management prerogative while preparing for cases to be filed, to make sure it’ll be air-tight and evidence will be preserve”, said Cardona.

Cardona said the alleged fraudulent claims were discovered in October this year when a certain member filed for re-adjustment only to find out that it was processed as a new claim instead.

“The central office discovered double claim for the same member and asked the region 1 office to explain until the Anti- Fraud Team saw irregularities in the processing of claims”, said Cardona.

Some reimbursements of claims were reportedly filed by an employee, not by members, but the processing was fast-tracked and the same employee who is related to the member, withdraw the amount of reimbursed claims.

Further probe revealed that the alleged irregularities have been going on since 2009.

However, the alleged fraudulent claims peaked after the implementation of ‘all case rates’ last year.

“We are talking of a seven digit amount (millions) here but we assure the members that our funds are intact but we need to stop this so it won’t happen again”, said Cardona.

He also assured a speedy investigation to penalize the people responsible for the allegations.

“We asks the understanding of our members as we are doing our best to fix this as we assure them that those involve in this is just a small percentage of our hardworking and honest employees”, said Cardona. (Hilda Austria)

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