PhilHealth organizes Task Force Kisapmata

The Philippine Health Insurance Corporation (PhilHealth) has created a task force to monitor reports of rampant abuse of the National Health Insurance Program by scheming institutional and professional health care providers nationwide, particularly those in the field of ophthalmology.

Through Board Resolution No. 1047, series of 2007 creating Task Force: Kisapmata, Lorna O. Fajardo, Acting PhilHealth President and CEO hopes to address the reported abuses of certain accredited health care providers and safeguard the National Health Insurance Fund and shield the Corporation from some unscrupulous and corrupt health care institutions and professionals.

Fajardo said that Task Force Kisapmata is a concerted effort of the Fact-Finding, Investigation and Enforcement Department (FFIED) and the Standards and Monitoring Department (SMD) of PhilHealth which did initial studies to address the issue on cataract cases and other ophthalmologic procedures.

Fajardo added that Task Force: Kisapmata will concentrate on validation of cataract claims through utilization review and conduct of actual investigation in specific regions or provinces where alarming trends on claims utilization for cataract cases are reported. The Task Force will include a representative from the Philippine Academy of Ophthalmology (PAO) who will act as an expert on clinical issues identified from the utilization review and may perform actual patient examination for validation. The other members of the task force are from FFIED, SMD and Legal Services offices of PhilHealth.

Among the other functions and responsibilities of the Task Force are to study the allegedly unethical and / or illegal recruitment schemes of some PhilHealth-accredited health care professionals and institutions for the sole purpose of enrolment and claiming with PhilHealth and to recommend possible solutions for policy consideration and legal action. It shall also present to the PhilHealth Board the results of its operations arising from these tasks.

“Through Task Force: Kisapmata, we hope to amend and improve on some of our policies and recommend legal actions to stop the alleged unethical practices,” Fajardo said. (PR)