Press Release
July 31, 2019

Hontiveros to file PhilHealth Insurance False Claims bill to deter fraud

Akbayan Senator Risa Hontiveros on Wednesday said that she will file a bill to prevent fraud from false claims and overpayments after Senator Panfilo Lacson said that the health insurance corporation incurred billions of losses due to alleged fraudulent benefit claims involving corrupt health officials.

Hontiveros said that she is planning to file a PhilHealth Insurance False Claims Act to deter and minimize fraud notwithstanding the penalties provided for under Section 38 E (2) of Republic Act No. 11223 or the Universal Health Care (UHC) Act.

"The seriousness and disturbing nature of these allegations should prompt a review of PhilHealth's anti-fraud mechanisms. Every peso lost to corruption in our health programs would mean that a citizen is deprived of potentially life-saving medication or treatment. Corruption makes our people unhealthy and even threatens their lives," Hontiveros said.

Hontiveros wants to improve PhilHealth's fraud detection mechanisms, including a shift from the current case rate payment to a diagnosis related grouping provider payment mechanism, and providing support to PhilHealth staff who flag anomalies. She said that with the implementation of the UHC Law, preventing, detecting, and reporting fraud becomes an even more important challenge that PhilHealth must address.

The Senator also said that there is a need to revisit the penalty of suspending hospital operations and seriously consider imposing monetary penalties that are at least three times the amount of detected fraud.

Hontiveros said that she was particularly alarmed over the report that PhilHealth continues to overpay fraudulent hospitals and clinics via "overstaying" or "ghost" patients, including WellMed Dialysis Center, whose accreditation was suspended for making false claims to PhilHealth for "ghost" dialysis patients.

Hontiveros said that in 2015, when she was then a board member of PhilHealth, she added her voice to questioning billions of pesos of claims on dubious treatments and operations allegedly made by several hospitals and eye clinics and their practice to "seek out" (hakot) large number of PhilHealth members to operate on. She said that operations should not be done on patients simply because they are members of PhilHealth, and doctors operating for the sake of insurance reimbursements should be held accountable.

The said issue became the subject of a Senate Blue Ribbon Committee investigation under then Senator Teofisto Guingona III.

"Mukhang tuloy-tuloy ang mga anomalya mula sa hakot operation ng mga eye clinics, ghost dialysis patients hanggang sa mga kontrobersyal na repayments. Hindi maaari ito," Hontiveros said.

"Defrauding the government and depriving countless Filipinos of access to health services is an unacceptable and criminal misuse of public money. Every single peso under our health programs could potentially spell the difference between life and death for our constituents. Let us make sure that it is well spent and will not end up in the pockets of the corrupt," Hontiveros said.

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