By Claudeth Mocon-Ciriaco, March 8 2019; Business Mirror
https://businessmirror.com.ph/2019/03/08/philhealth-to-boost-drive-vs-fraud/
Image Credit to Philippine Star
Following the enactment of the Universal Health Care law, the Philippine Health Insurance Corp. (PhilHealth) has vowed to intensify its campaign against fraud with the National Bureau of Investigation (NBI) as one of its major partners.
“We cannot afford to fall short on our efforts to halt the progression of these deceitful practices, especially now that the National Health Insurance Program [NHIP] needs a strong and stable fund to enforce the Universal Health Care Act,” PhilHealth Acting President and CEO Dr. Roy B. Ferrer said after the signing of a memorandum agreement with the NBI.
Aside from its tie-up with the NBI, the PhilHealth also joined hands with the Philippine Medical Association and Philippine Hospital Association to deal with erring health-care institutions, while the Professional Regulation Commission was tapped to dispense sanctions to dishonest health professionals.
“We take it upon ourselves to initiate collaborations with relevant government agencies and private entities to uphold the moral standards by which our society must prosper,” Ferrer added.
He assured that these partnerships ascertain the success of anti-fraud activities in order to ensure reliable and consistent services for PhilHealth beneficiaries.
Last year, PhilHealth filed about 5,000 cases with its Prosecution Department against health-care institutions and professionals.
The corporation only takes 17 days to process a case buildup that entails a thorough data-gathering method.
Fraudulent transactions spanning from professionals recruiting members into a bogus “free wellness program” only to be paid for by PhilHealth to hospitals and dialysis centers, including filing claims for deceased patients, were exposed. These cases are now being actively investigated and prosecuted.
Stiff penalties and fines were imposed against those involved and measures were formulated to prevent future occurrence of fraud. These anti-fraud efforts relied on truthful evidence extracted with careful deliberations.
As a testament to its stance against fraud, PhilHealth castigated 71 hospitals across the nation due to breach in accreditation, misconduct and other grounds that warrant such punishment.
Moreover, members of the so-called mafia within its ranks have been uncovered and suspended by PhilHealth due to a string of offenses against the corporation. Investigations were also conducted to ensure proper actions against the dishonest officials.
“Despite our commitment to fight fraud, we do not flail our swords aimlessly and chop down an innocent arm…even if goals for anti-fraud efforts are set, devious practices are not tolerated just for the sake of reaching those goals. We are beyond that,” he stressed.
The corporation ensures its counter-fraud measures are guided by integrity, upheld by ethics and dispensed by precision.