PhilHealth staff, hospitals face raps
RAMPANT FRAUDULENT CLAIMS
A fact-finding team of the Philippine Health Insurance Corporation (PhilHealth) has already filed administrative and criminal complaints before the Ombudsman against nine employees of PhilHealth Region 1 for processing fraudulent claims that defrauded the government, in this case, PhilHealth, estimated to top P10 million.
This was bared by Dr. Leo Douglas Cardona, regional vice president of PhilHealth Region 1, in a news conference on Feb. 12 but he withheld the names of the PhilHealth employees involved and the hospitals whose personnel or management may have connived with officials of the agency for the processing of the fraudulent transactions.
“We will also file a separate administrative cases against hospitals, their personnel or management for allowing their facilities to be used. Whether the hospitals were involved, whether their top management is involved, that is not the issue,” Cardona said.
The legal office of PhilHealth Region 1 said these irregularities were discovered by PhilHealth central office in November last year and the investigation is expected to review transactions that date back to to 2009.
According to Cardona, the irregularities were initially detected by the central office, after regular monitoring by the standard department and the anti-fraud team followed on the cases.
He admitted “Nagkulang kami ng safeguards which allowed our employees to manipulate the processing (of fraudulent claims) using the access codes of others”.
He cited one paarticular claim that listed treatment of colon cancer, prostate cancer and brain cancer involving one patient alone.
It was learned some of the respondents were reassigned to another area while the cases are still being investigated, one, he said, went to work in Dubai.
Cardona said the case involved fraudulent claims and conflicts of interest resulting from connivance between erring PhilHealth Region 1 staff and staff of government and private hospitals.
He said the irregularities are continuing to this day as the latest fraudulent claim discovered was dated last February 11, 2015 so more cases will be filed in the weeks ahead. (Leonardo Micua)
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