P4-B Philhealth scam bared
By Veronica Uy
Last updated 08:25pm (Mla time) 05/29/2007
MANILA, Philippines -- Some doctors and hospitals have defrauded the government’s Philippine Health Insurance Corp. (PhilHealth) by P4 billion in unnecessary or overpriced medical procedures since 1995, an official has disclosed to the Senate.
Dr. Madeleine Valera, PhilHealth vice president for health finance policy, said fraudulent claims included one doctor who conducted more than 2,000 cataract surgeries worth P17 million in one year. She said among the cases being investigated by PhilHealth were those involving circumcisions and toenail extractions.
“It would appear [from medical records submitted to PhilHealth] that a lot of Filipinos are supot [uncircumcised] and have infection on their toenails,” she told a hearing Tuesday.
“May mga raket din ang mga doctor [Doctors also have their rackets], more as individuals than as syndicates. Some doctors are in on the scam. Many have earned millions from PhilHealth,” Valera said.
She said the scam involved some “scalawag” doctors treating “ghost patients,” and making “dubious claims.” Others “harvest” these patients by enrolling them in PhilHealth before they are treated.
Valera said that in some cases, hospital-based pharmacies were also involved. She said doctors would prescribe medicines that were not needed by the patient but only to pad the hospital bills.
Senator Richard Gordon, head of the Senate committee on government corporations who called for the off-session hearing, said, “The national government is the biggest violator of premium payments,” with P5 billion in unpaid PhilHealth premiums.
The hearing was conducted following published media reports that some hospitals were going on “holidays” as a reaction to the passage of the law banning them from detaining patients who could not pay the entire hospital bill.
Melinda Mercado, PhilHealth senior vice president for operations, admitted that PhilHealth had been late in paying for the hospital bills of their members. She explained that this was because of a new PhilHealth system that would allow verification of premium payments before hospitals were actually paid.
“It is not for lack of money. [The delayed payment] is an operational problem. We have shifted from a localized system to an integrated system. We are still adjusting to this centralized computerized system where all data may be checked,” she said.
Mercado said the delayed payment was also caused by the mass migration of doctors, who acted as evaluators of medical cases. Medical cases are evaluated to determine actual medical needs.
“Doctors are leaving the country, many as nurses. And we have been finding it difficult to find replacements,” she said.
Gordon said the hearing exposed the weaknesses in the Philippine health system. “These overcharging and harvesting of patients are a sad commentary of the times. This problem needs to be addressed by the PRC [Professional Regulation Commission] and medical associations so that these malpractices are excised and exorcised,” he said.