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  1. #1
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    Santisima! PHILHEALTH SCAM naman ngayon!

    P4-B Philhealth scam bared
    By Veronica Uy
    INQUIRER.net
    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.

  2. #2
    the doctors and hospital admin and everyone else involved here should be jailed. i hope the govt puts up a special prosecutor's group to bring these people to the couts and jail them!

    i have a question though --- did the philhealth officials have to wait for it to reach P4Billion before doing something about it??!!! when they know scams are being done, even if its P5T, should they have done something legally against these doctors? these philhealth officials should be taken to the courts too for incompetence and stupidity!

  3. #3
    Quote Originally Posted by abcxyz View Post
    the doctors and hospital admin and everyone else involved here should be jailed. i hope the govt puts up a special prosecutor's group to bring these people to the couts and jail them!

    i have a question though --- did the philhealth officials have to wait for it to reach P4Billion before doing something about it??!!! when they know scams are being done, even if its P5T, should they have done something legally against these doctors? these philhealth officials should be taken to the courts too for incompetence and stupidity!
    Why the doctors and hospital staff, shouldn't it be Philhealth officials who should be jailed?

  4. #4
    Quote Originally Posted by AlanNathaniel View Post
    Why the doctors and hospital staff, shouldn't it be Philhealth officials who should be jailed?
    it is the doctors who committed the fraud in the first place. and i suppose in many cases in collusion with hospital staff. the doctors and hospital staff benefited from the scam - they pocketed money for procedures that were not done.

    philhealth officials should be jailed or at least fired from their jobs for being incompetent and not exercising due diligence and control - allowing the fraud to reach P4B! or maybe they should be charged with economic sabotage given the huge amount involved. i feel being fired from their jobs is not enough punishment.

  5. #5
    That's why they should ABOLISH those systems. Revert back to fully PRIVATE systems.

  6. #6
    Quote Originally Posted by abcxyz View Post
    the doctors and hospital admin and everyone else involved here should be jailed. i hope the govt puts up a special prosecutor's group to bring these people to the couts and jail them!

    i have a question though --- did the philhealth officials have to wait for it to reach P4Billion before doing something about it??!!! when they know scams are being done, even if its P5T, should they have done something legally against these doctors? these philhealth officials should be taken to the courts too for incompetence and stupidity!
    I heard the health secretary on radio yesterday when I was going to Manila Times. He said that they were the ones who caught it and are now investigating it. But he said that now, Philhealth's asset rose to P 60 billion and it is one of the biggest ...

    Sa racket na ito, kasabwat ang napakaraming COA, ADMIN., HEALTH OFFICIALS ... alam ni Secretary ito. These doctors cannot extort and get money from Philhealth without the blessing of the secretary.


    Remember the sister of Chavit, Honeygirl Singson who was the QUEEN of the PHILH CARDS to push GMA fake presidency thru abalos kitty? She suffered stroke at Baguio ...

    National (as of 3:59 AM)


    http://www.abs-cbnnews.com/storypage.aspx?StoryId=79076

    Palace orders probe on false PhilHealth claims

    http://www.abs-cbnnews.com/storypage.aspx?StoryId=79076



    By PAOLO ROMERO

    The Philippine Star

    Malacañang Wednesday directed Health Secretary Francisco Duque III to look into reports that some private hospitals have been making false claims to the Philippine Health Insurance Corp. (PhilHealth), which cost the state-owned firm huge losses.

    Executive Secretary Eduardo Ermita also admitted that the government, particularly local government units (LGUs), has contributed to some of PhilHealth’s losses, but he gave assurances the arrears would be paid.

    Ermita issued the statement after a Senate inquiry revealed that false and exorbitant claims of some private hospitals bled PhilHealth of some P4 billion, on top of its losses of about P5 billion in unremitted premium payments.

    PhilHealth vice-president Madeleine Valera told a Senate hearing on Tuesday that the state health insurance firm has recorded a total of P4 billion in losses since 1995 because of the claims made by physicians and hospitals for "irrational" procedures and the bloated prices of medicine.

    She also said the government has not paid P5 billion in premiums for cardholders since 2001, making the government the top violator in terms of remitting the premiums.

    The issuance of PhilHealth cards by President Arroyo during the campaign for the 2004 presidential elections was an issue used against her.

    "Duque has been directed to take a closer look at this. Because the charges leveled are that there are private hospitals and private doctors taking advantage of the PhilHealth program when there were really no actual patients. So this is now the subject of an investigation being done by the DOH (Department of Health)," Ermita said.

    He said the government will pay its arrears, but the Palace wants to be sure the money will not end up with the hospitals making dubious claims.

    "We want to be sure that the money that the national government will put in will be put to good use," Ermita said, "But we want to determine how true or how accurate the reports are that the PhilHealth program is being taken advantage of by private practitioners and hospitals."

    Valera told the Senate panel that doctors and certain hospitals took advantage of their patients by claiming benefits and privileges from PhilHealth after the operation or check-up.

    She said some hospitals even had "ghost patients," while some surgeons performed unnecessary operations.

    In one instance, Valera said, a surgeon earned P17 million in a year by performing at least 2,000 cataract and other eye operations.

    She said a doctor may claim between P12,000 and P16,000 per eye for each operation, or P24,000 to P32,000 for both eyes.

    Valera said the doctor could report having performed at least two operations on a patient and could claim P64,000 from PhilHealth.

    She said physicians could also add some provisions in their reimbursements and manufacture claims by asking patients to sign blank documents even for consultations and minor procedures.

    "The patients won’t know afterwards what the doctors and hospitals are claiming on their behalf," she said.

    Valera said doctors and hospitals could likewise prescribe expensive medicine and earn from this.

    "Because of our old system, we had to pay these claims. It is difficult to prevent sophisticated fraudulent acts by my colleagues, the doctors," Valera said.

  7. #7
    Quote Originally Posted by abcxyz View Post
    it is the doctors who committed the fraud in the first place. and i suppose in many cases in collusion with hospital staff. the doctors and hospital staff benefited from the scam - they pocketed money for procedures that were not done.

    philhealth officials should be jailed or at least fired from their jobs for being incompetent and not exercising due diligence and control - allowing the fraud to reach P4B! or maybe they should be charged with economic sabotage given the huge amount involved. i feel being fired from their jobs is not enough punishment.
    tanggalin pati mga lisensya nyan....

  8. #8
    grabe naman, benefits para sa mga mahihirap, ninanakaw pa ng mga doktor. dapat ikulong ang mga ganitong klaseng mga doktor at tanggalan ng licenses.

    may mga mabubuting doktor naman na di mapagsamantala, baket di sila ang gayahin?

    tsk tsk tsk.

  9. #9
    Quote Originally Posted by liplocker View Post
    grabe naman, benefits para sa mga mahihirap, ninanakaw pa ng mga doktor. dapat ikulong ang mga ganitong klaseng mga doktor at tanggalan ng licenses.

    may mga mabubuting doktor naman na di mapagsamantala, baket di sila ang gayahin?

    tsk tsk tsk.
    Moro-moro, farce so to speak, and gagawin nitong c Secretary na investigation sa kangaroo court, kasabwat ang damin ng Tao niya. Pati mga usec at staff, mga ahente na ng panDARAMBONG ...

    KARMA na lang ang kapalit, WHITE WASH ang ending nito, why? Sila ba pakukulong ng OMBUDSMAN?

    DoH probes PhilHealth’s ‘P4-B losses to fraud’


    http://www.tribune.net.ph/nation/20070601nat1.html


    06/01/2007

    Health Secretary Francisco Duque III yesterday said the Department of Health (DoH) is looking into the veracity of the reports that the Philippine Health Insurance Corp. (PhilHealth) lost a total of P4 billion due to fradulent claims over a nine-year period.

    Nonetheless, “there is no hard evidence (yet) to show that PhilHealth has lost P4 billion and (at the momment,) this is just (a) speculation,” Duque told a press conference in Puerto Princesa City, Palawan province Wednesday.

    Duque, who was PhilHealth president before he became Health Secretary in June 2005, said there was nothing to substantiate the PhilHealth’s claims that it has lost some P4 billion to dubious and exorbitant claims from 1997 to 2006.

    He further said even assuming that there had been fraudulent claims, the P4 billion the PhilHealth apparently lost to such ploy was just four percent of the total benefit payout of the state health insurance firm, which has reached to P100 billion, including the almost 10 percent administrative cost.

    ”It is only 4 percent or P350 to P400 million a year, if based on the P100 billion total benefit payout released by PhilHealth to its members and the indigent beneficiaries. But the P4 billion is a shocking figure,” he said.

    Duque, however, said the DoH has been able to dramatically reduce the incidence of fraud in the national health insurance program, as the PhilHealth had been losing an average of 33 percent to fraudulent claims before 1995.

    He said the PhilHealth is presently in a robust status financially, having a stable asset of P61.2 billion.

    The figure is increasing and could open up more benefits for the PhilHealth members availing premium payments, he added.

    To date, it has 25 million unprecedented indigent beneficiaries.

    Furthermore, Duque said the PhilHealth released P19 billion last year and P20 billion for the year 2007 to help Filipinos, especially those in the marginalized sector, to avail of the government’s delivery of health services.

    Duque also said the DoH’s budget is entirely devoted to health services, of which P2.8 billion will be used for immunization, deworming, vitamin E and iron supplementation and other health and social services.

    Duque was in Puerto Princesa City for the DoH’s 5th National Health Sector staff meeting which is scheduled to be held at the Legend Hotel from last Wednesday to today.

    The three-day meeting is being attended by 182 DoH officials. PNA

  10. #10
    Quote Originally Posted by the_BuGs View Post
    tanggalin pati mga lisensya nyan....
    Santa Banana! Nabuking sila, lolokohin na naman tayo, by FAKE audits. Talagang kaya dami sa kanila na STROKE at CANCER, sobra na silang magnanakaw!

    http://www.abs-cbnnews.com/storypage.aspx?StoryId=79401



    National (as of 8:50 PM)

    PhilHealth to issue financial statement Monday


    http://www.abs-cbnnews.com/storypage.aspx?StoryId=79401


    The Philippine Health Insurance Corp. (PhilHealth) said it will release its latest financial statement Monday after declaring losses due to fraudulent claims, ABS-CBN News reported Saturday.

    The report said Malacañang has already ordered the Department of Health to investigate a report that dubious and exorbitant claims made by some medical practitioners practically robbed the institution of P4 billion.

    This was revealed by PhilHealth vice president Madeleine Valera in a Senate hearing Tuesday. Valera added that on top of P4 billion in dubious claims, the government has failed to remit P5 billion in premium payments.

    Health Secretary Francisco Duque III, however, said his department is now determining how much PhilHealth is losing due to dubious claims. He said the DOH is investigating more than 400 cases of fraudulent claims but he noted that these might not reach P4 billion.

    PhilHealth Chief Executive Officer Valentin Guanio said the institution remains financially stable with a very good cash flow and liquidity which strengthens its ability to pay all benefit claims and other necessary funding requirements.

    Guanio stressed the fraudulent claims made against PhilHealth by some medical practitioners are exceptionally few.

    He said the fraudulent claims are committed by "a few unscrupulous and inconsiderate bad eggs among the many upright and honest hospitals and doctors."

    In 2004, PhilHealth had filed 425 cases against hospitals and physicians for multiple filing of claims and for extended hospital confinement that did not actually happen.

    Guanio said PhilHealth is revoking the accreditation of several doctors and hospitals found guilty of fraudulent claims.

    He said PhilHealth has tapped the services of the National Bureau of Investigation and the Philippine National Police to prosecute fraudulent claims. With a report from The Philippine Star

  11. #11
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    I bet these scams are perpetrated by Pinoys who went back into the Philippines after they were accused of Medicare fraud in the US.
    In California and New Jersey alone several Pinoys were indicted for Medicare fraud and they were relatives or in-laws.

  12. #12
    Quote Originally Posted by ArnoldZ View Post
    I bet these scams are perpetrated by Pinoys who went back into the Philippines after they were accused of Medicare fraud in the US.
    In California and New Jersey alone several Pinoys were indicted for Medicare fraud and they were relatives or in-laws.
    Of course, kasabwat lahat ng usec, asec as of course and sec of DOH,
    bulok lahat yan, kaya KARMA is the only way to punish these WITCH doctors:


    oplan TAKIP TAKIP na naman, bistado na WHITE WASH na naman:

    http://newsinfo.inquirer.net/breakin...ticle_id=69754


    PhilHealth is healthy, official insists


    By Edson C. Tandoc Jr.
    Inquirer
    Last updated 07:20am (Mla time) 06/06/2007

    MANILA, Philippines -- PhilHealth is healthy and running after cheaters.

    This was the assurance made by officials of the Philippine Health Insurance Corporation (PhilHealth) after a Senate hearing revealed that the government agency lost P4 billion to fraudulent claims.

    PhilHealth officer-in-charge Valentin Guanio said that this year, they filed 427 cases for alleged fraudulent claims against hospitals and doctors and about 4,000 cases in the last seven years.

    The cases, filed from 2000 to 2007, involved some P26 million -- way below the P4 billion reported losses.

    Guanio said it was possible that there could be “undetected” fraudulent claims along the way, but the figure would not be more than P26 million.

    This was in contrast to earlier reports quoting PhilHealth vice president Madeleine Valera who said the government company lost about P4 billion due to fraudulent claims.

    On Tuesday, Valera clarified that she was only talking about a “benchmark” figure.

    Health Secretary Francisco Duque III also said the quoted P4-billion figure was mere “speculation” he himself made in 2003. It refers to the possible amount of losses to bogus claims in a span of 10 years.

    Duque explained that most fraudulent claims came from primary hospitals, affecting about 3,000 hospital beds, or close to 4 percent of the 85,000 total hospital bed capacity in the country.

    In mentioning P4 billion, Valera said she just took 4 percent of the P100-billion cumulative reimbursements and administrative expenses of PhilHealth in the last 10 years.

    She explained that this was just a reference figure used to assess if fraudulent claims were growing higher or lower.

    She said that in the last few years, fraudulent claims on PhilHealth were way below 4 percent.

    “I was not allowed to explain how I got the number,” she told the Philippine Daily Inquirer, referring to her media interviews during the Senate hearing.

    Guanio said it could even be below 2 percent, citing only the number of cases they had so far filed. The most common modus operandi is having “ghost patients,” or claiming payments for patients who never existed, and declaring a longer period than the actual duration of confinement.

    Duque said they were already setting up a database to detect suspicious trends in requesting reimbursements.

    “(PhilHealth) is perhaps the second, if not the healthiest of all the government-owned corporations. It spent only P17 billion last year, when it collected about P23 billion,” he said.

    To detect fraud, Guanio said they have antifraud, arbitration and prosecution teams, all employing a total of 100 of the company’s 4,000 employees.


  13. #13
    Quote Originally Posted by ArnoldZ View Post
    I bet these scams are perpetrated by Pinoys who went back into the Philippines after they were accused of Medicare fraud in the US.
    In California and New Jersey alone several Pinoys were indicted for Medicare fraud and they were relatives or in-laws.
    Lagot si Secretary at mga usec niya kay Lacson, 4 na mistah ... pati si Vicky Toh, FG .. naku, di na ako manood ng ch 2 at 7, sa senado na lang ako pupunta .. mas exciting pa itong phil scam ...

    PhilHealth in danger of extinction by 2016


    http://business.inquirer.net/money/b...ticle_id=70065


    By Veronica Uy
    INQUIRER.net
    Last updated 06:00pm (Mla time) 06/07/2007


    MANILA, Philippines -- The Philippine Health Insurance is in danger of extinction by 2016 if it does not get new members and if premiums are not increased, Senator Richard Gordon said in a press conference Thursday.

    After the second hearing on PhilHealth, Gordon said non-payment of premiums, principally by the government, is endangering the system. The government owes PhilHealth P5 billion in unpaid premiums since 2001.

    Gordon said the financial health of PhilHealth is critical to the health situation in the Philippines.

    “Unpaid premiums and fraudulent claims are among the reasons why PhilHealth is in danger but eventually it is non-expansion of the membership and the non-increase of the premiums to be paid (that will do it in),” he said.

    Asked why government has not paid the premiums, he said: “They did not say. But I assume it wasn’t allocated because I think they wanted to lessen the deficit.”

    Gordon said PhilHealth officials count coverage in 18 percent of families. “But when I asked them about the coverage of individuals, they didn’t have an answer,” he said, adding that he’s batting for universal coverage for all Filipinos.

    Guests at the hearing proposed that the Medical Practice Law be amended to allow PhilHealth to go after doctors who make excessive charges, charge even medical outreach programs, and “farm patients,” or treat only those who are PhilHealth members.

    Gordon clarified that the estimate four percent of total contributions -- or P4 billion of the P100 billion contributions -- in fraudulent claims made by doctors and hospitals is the international standard.

    “Although I think we have a lot more than four percent,” he said.

    Gordon said he will look into the issue and make sure that there is money for PhilHealth contributions.

  14. #14
    PhilHealth benefits rich, not poor Filipinos – DOH official

    AIE BALAGTAS SEE, GMANews.TV
    02/19/2010 | 01:47 PM

    A 67-year-old coffee farmer from Tagaytay who had been having difficulty swallowing since December found out he had tuberculosis and cancer after a series of medical examinations. His doctor prescribed antibiotics and several therapies, but the farmer decided to simply go home, worried about his P43,000 pesos debt for hospital fees and the future of his nine children.

    "This is what it means to live in a fragmented health care system," said Dr. Jose Acuin, an expert in clinical research and the director for Medical Quality Improvement of the Medical City. He did not reveal the identity of his patient in line with the profession’s confidentiality requirement.

    By fragmented health system, former Health Secretary Alberto Romualdez explained that only those with money who often have adequate health insurance can fully pay medical bills. “The near-poor and the lower middle classes can become impoverished to meet out-of-pocket payments for health care," Romualdez said. “The very poor don’t even have pockets," he added.

    Worse, one of the reasons for the inequality in health services is the failure of Philhealth, the government’s health insurance program, to properly target poor households and provide correct information to beneficiaries, according to Liezel Lagrada of the Department of Health (DOH).

    “The enrollment coverage of Philhealth favors the rich due to [its] weak poverty targeting policy," said Lagrada, officer-in-charge of the Health Policy Development and Planning Bureau of the DOH.

    The three health specialists were among the pool of medical experts invited by the Zuellig Family Foundation to address the first Health Outlook Forum last January at the AIM center in Makati City, which tackled health inequalities in the Philippines.

    Lagrada presented a 2006 study that showed more Philhealth funds going to well-to-do families instead of the less privileged. According to the study, P5.2 billion in Philhealth reimbursements in 2003 went to the richest 20 per cent of beneficiaries, while only P1.4 billion went to the poorest income quintile.

    Free medical services

    Moreover, Philhealth’s efforts to develop benefit packages for the poorer segment of the population often become useless because they are not aware of the sponsored programs that allow people who have insufficient income to avail of free medical services.

    “It’s [the Philhealth benefits] there but nobody is using it," said Lagrada. “Since members do not know that they can actually get them for free, especially in the sponsored programs, they don’t access these services."

    Among these free services are chest x-ray, sputum microscopy, fecalysis, urinalysis, complete blood count, breast examination, annual digital rectal exam, blood pressure measurement, and visual screening. Consultations on “lifestyle modification" such as cessation of smoking are also covered.

    Lagrada added that poor people often seek medical services from rural health units (RHU), but only half of these centers are accredited by the Philhealth.

    Established through the National Health Insurance Act of 1995, Philhealth aims to reduce out-of-pocket spending as well as the inequities in health financing.

    In 1999, the DOH Health department came up with a health sector reform agenda to resolve Philhealth’s “inadequate benefit support with bias towards in-patient care and limited population coverage" arising from problems with program implementation.

    More than a decade later, however, nearly half of all Filipino families still rely on their own pockets, Lagrada said.


    http://www.gmanews.tv/story/184299/p...s-doh-official

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