State health insurer, Philippine Health Insurance Corporation (PhilHealth) strongly advises health care providers not to engage in unethical acts such as upcasing of claims.
The Agency received various reports relating to health care providers colluding with patients to declare minor respiratory symptoms as COVID-19 case for higher benefit reimbursements.
In view of the increase in reports of claims manipulation, state health insurer urges patients and their families to directly report such illegal acts to PhilHealth.
The Agency is likewise calling on the public to be vigilant of such acts and fully cooperate with PhilHealth by providing proofs to support the investigation.
“We call on the public to cooperate with us to immediately curtail these wrongdoings. We should protect the National Health Insurance fund, because it is a public fund, it is your money,” PhilHealth President and Chief Executive Officer Dante A. Gierran said.
PhilHealth assures whistleblowers that complete confidentiality of reports as well as their protection will be given as provided by law.
To further strengthen its campaign against unlawful acts, PhilHealth has earlier initiated collaborations with the National Bureau of Investigation to detect, deter, and prosecute fraud committed by hospitals and professionals.
The state health insurance chief stressed that he will not tolerate deceitful practices made by some providers in order to take advantage of the uncertainties brought about by the pandemic.
“PhilHealth shall not hesitate to use full force of the law to those caught engaging in these illegal practices,” he said.
The public may send their reports pertaining to these fraudulent acts through email at whistleblower@philhealth.gov.ph; actioncenter@philhealth.gov.ph; and opceo@philhealth.gov.ph or by mail addressed to the Office of the Corporate Secretary, Room 1711, 17th Floor Citystate Centre, 709 Shaw Blvd., Pasig City. ###
PhilHealth reiterates warning against health insurance fraud
State health insurer, Philippine Health Insurance Corporation (PhilHealth) strongly advises health care providers not to engage in unethical acts such as upcasing of claims.
The Agency received various reports relating to health care providers colluding with patients to declare minor respiratory symptoms as COVID-19 case for higher benefit reimbursements.
In view of the increase in reports of claims manipulation, state health insurer urges patients and their families to directly report such illegal acts to PhilHealth.
The Agency is likewise calling on the public to be vigilant of such acts and fully cooperate with PhilHealth by providing proofs to support the investigation.
“We call on the public to cooperate with us to immediately curtail these wrongdoings. We should protect the National Health Insurance fund, because it is a public fund, it is your money,” PhilHealth President and Chief Executive Officer Dante A. Gierran said.
PhilHealth assures whistleblowers that complete confidentiality of reports as well as their protection will be given as provided by law.
To further strengthen its campaign against unlawful acts, PhilHealth has earlier initiated collaborations with the National Bureau of Investigation to detect, defer, and prosecute fraud committed by hospitals and professionals.
The state health insurance chief stressed that he will not tolerate deceitful practices made by some providers in order to take advantage of the uncertainties brought about by the pandemic.
“PhilHealth shall not hesitate to use full force of the law to those caught engaging in these illegal practices,” he said.
The public may send their reports pertaining to these fraudulent acts through email at whistleblower@philhealth.gov.ph; actioncenter@philhealth.gov.ph; and opceo@philhealth.gov.ph or by mail addressed to the Office of the Corporate Secretary, Room 1711, 17th Floor Citystate Centre, 709 Shaw Blvd., Pasig City. ###
Statement on Health Insurance Coverage of Patients Admitted in Tents
In a recent Congressional hearing, EVP/COO Nerissa Santiago clarified that if the services given to patients in tents were part of in-patient care then these should be covered by the current inpatient Covid-19 packages of the program, as opposed to stays in non-accredited Community Isolation Unit tents which are not compensable under existing rules.
PhilHealth fully acknowledges the current situation where patients are temporarily placed in tents because hospitals can no longer admit them in regular hospital beds.
PhilHealth guarantees that Covid-19 patients are entitled to health insurance coverage for RT-PCR tests, isolation in accredited community isolation units, and hospitalization for mild to critical cases of Covid-19.
Be it Covid-19 or not, patients should be afforded with all the financial help as guaranteed by the Universal Health Care Law. Pursuant to this, PhilHealth has been reviewing existing policies to better respond to the extraordinary demands brought about by this pandemic, with the best interest of the patients in mind. Enhanced guidelines will be issued the soonest to ensure that adequate financial protection is duly provided to the patients without compromising quality of care.”
On the other hand, the reported charges of P1,000/hour will be investigated for possible violation of pertinent laws and rules. ###
(Sgd.)Atty. DANTE A. GIERRAN, CPA President and CEO