House moves to 'fraud-proof' PhilHealth law
A consolidated move in the Lower House is underway to introduce major amendments in the country's National Health Insurance Program (NHIP) otherwise known as the PhilHealth Law.
An offshoot of the reported fraudulent claims amounting to at least P400 million in the past three years alone, Rep. Janette Loreto-Garin (First District, Iloilo) said the amendments will hopefully make the PhilHealth Law "fraud-proof."
As such, top PhilHealth officials were asked of specific recommendations on specific provisions that were subject of abuse by private hospitals and doctors in private practice.
"PhilHealth should not die in this administration. We cannot allow that it continue to bleed from the abuses of certain hospitals and medical professionals. This is a great health care program and it needs our support," Rep. Garin said in The News Today (TNT) interview.
The House Bill once proposed is expected further to see stiffer penalties for violators foremost of which is the immediate revocation of PhilHealth accreditation of member-hospitals and member-doctors. Changes will also be introduced that will ensure equal liabilities on both the hospital and the physician concerned in the event that fraud and irregularities will be established.
To note, an investigation was ordered here in Western Visayas that eventually validated fraudulent claims made on Cataract case claims. The number of claims reached thousands that was somehow centered on two private hospitals in the region, one of which was the Bacolod Our Lady of Mercy Specialty Hospital.
Evangeline Johnson, hospital Chief Operating Officer has since denied any wrongdoing saying she has a "spotless" record when it comes to her integrity.
TNT in an independent investigation managed to get a 'shortlist' of the hospital's regular doctors doing cataract operations here. The claims for professional fee of the group are pegged in millions making them a regular of the "millionaires' club" in PhilHealth's roster of member-doctors.
The region's probe has now been elevated into the PhilHealth Central office with yet another investigation ordered and cases readied. TNT learned that first set of charges prepared will have at least ten counts of fraud as backed by 50-cataract case claims picked on random by the probe body.
Meantime, recruitment/referrals of agents/seekers continue in Iloilo. TNT was informed by the senior citizens in San Miguel, Iloilo that Bacolod-based Roy Pabriana is expected to come back and set the second batch of the group for a cataract operation on November 4.
Pabriana when reached by TNT stressed that all that he did was to "refer" and not recruit the seniors with cataracts for operation. Pabriana is associated with Ilonggo eye specialist, Dr. Nonito Avecilla, one of the Ophthalmologists here who has the most number of Cataract case claims with the PhilHealth.
The Pabriana-Avecilla Cataract cases are done in Bacolod Our Lady of Mercy Specialty Hospital.