PhilHealth to investigate alleged incidents of Covid-related health insurance abuse

·2 min read

THE Philippine Health Insurance Corp. (PhilHealth) announced that it will investigate alleged incidents of upcasing or any form of health insurance abuse related to the coronavirus disease 2019 (Covid-19).

The agency noted a proliferation of video posts showing incidents of health care providers allegedly colluding with patients to declare minor respiratory symptoms, such as asthma, as Covid-19 symptoms to claim higher benefits.

“If found true, the incidents described in the video posts refer to upcasing or claiming for a related illness or procedure of higher severity or complexity to gain higher benefit payment,” said PhilHealth.

According to the state health insurer, upcasing is a form of health insurance fraud with a penalty of P200,000 for each count or suspension of contract of the health care provider up to three years or both.

It also constitutes a criminal violation punishable by imprisonment for six months and one day up to six years upon the discretion of the court under Section 38 of the Universal Health Care Law.

READ: PhilHealth 7 lists 26 accredited quarantine facilities in Cebu

Warning

The state health insurer also warned those who post videos of these alleged incidents without any proof to support their claims, saying they are not helping the public be at ease amid the pandemic.

“They instead malign and compromise the reputation of hospitals, doctors, and even the agency itself, acts that may lead to legal actions such as cyber libel and violation of Article 154 of the Penal Code, criminalizing the publication of false information that may endanger the public order or cause damage to the interest or credit of the State,” said PhilHealth.

On Oct. 29, 2020, the National Bureau of Investigation (NBI) 7 filed graft charges against four officers of Perpetual Succour Hospital in Cebu City and eight officials of Philhealth 7 for their alleged involvement in Covid-19 benefit claims anomalies.

NBI 7 also filed on February 8, 2021 criminal charges against eight officials of PhilHealth 7 and three officers and employees of Chong Hua Hospital in Cebu City for their alleged failure to identify falsified documents that made a patient appear that he tested positive for Covid-19 and was a frontliner.

READ: Philhealth 7, hospital officers charged for ‘false’ Covid-19 claim

Appeal

PhilHealth appealed to the public to report and bring evidence of unethical acts directly to their office “so that the agency can act swiftly.”

Concerned citizens and whistleblowers can report to the nearest PhilHealth offices while observing minimum health protocols or call PhilHealth Central Office at (02) 8441-7442.

They can also send an email to whistleblower@philhealth.gov.ph, actioncenter@philhealth.gov.ph, or opceo@philhealth.gov.ph. They also have the option to send a letter addressed to Room 1711, 17th Floor Citystate Centre, 709 Shaw Boulevard, Pasig City.

“PhilHealth assures utmost confidentiality of reports as well as protection and possible assistance to the whistleblower as provided for by law,” the agency said. (NRC/With PR)