Amid losses, PhilHealth says it can still pay claims

Amid losses due to fraudulent claims, the Philippine Health Insurance Corp. (PhilHealth) made assurances that it can pay all legitimate claims from members.

PhilHealth CEO 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.”

“We are very well aware of such activities, that’s why we have instituted stringent measures to curb such malpractices,” Guanio said.

Guanio issued the statement after PhilHealth vice president Madeleine Valera revealed that dubious and exorbitant claims made by some medical practitioners practically robbed the institution of P4 billion.

Valera told a Senate hearing Tuesday that on top of P4 billion in dubious claims, the government has failed to remit P5 billion in premium payments.

PhilHealth said they are now investigating a total of 217 fraudulent claims.

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 (NBI) and the Philippine National Police (PNP) to prosecute fraudulent claims.

“In fact, for 2006 we have prosecuted 425 cases and have elevated to the health insurance arbiter some 181 cases related to fraudulent claims. We are currently investigating 217 cases of the same nature,” Guanio said.

Health Secretary Francisco Duque III said measures have been put in place to discourage spurious claims against PhilHealth.

The measures include strict monitoring of all documents being submitted by doctors to PhilHealth, Duque said. – Sheila Crisostomo