PhilHealth moves to deter spurious cataract operations
The Philippine Health Insurance Corp. (PhilHealh) and the Philippine Academy of Ophthalmologists (PAO) have entered into an agreement to help deter spurious claims and unethical practices in cataract surgeries.
The memorandum of agreement, signed on Sunday by PhilHealth Acting President and Chief Executive Officer Lorna Fajardo and PAO President Dr. Dominga Padilla, provides for closer coordination between the PhilHealth and PAO concerning claims for cataract operations.
Under the agreement, PhilHealth will coordinate with PAO in the resolution of issues arising from claims for cataract surgery patients recruited through medical missions or other recruitment schemes. It will also
provide support to PAO in the investigation or verification of claims for cataract surgeries.
PAO,which has 1,300 members and 10 regional chapters, has agreed to discipline its members with violations based on those referred by PhilHealth. It also agreed to coordinate with PhilHealth in the conduct of PAO-sponsored community-based cataract projects to properly identify claims for payment.
PhilHealth last month stopped the payment of claims for cataract surgery during medical missions and through recruitment schemes amid irregularities in claims of hospitals and doctors involving hundreds of millions of pesos.
It has also filed administrative cases against doctors and three hospitals in Negros Occidental in relation to irregularities in insurance claims for cataract surgeries.
The doctors and hospitals are facing a total of 34 counts of violating Republic Act 7875 (National Health Insurance Act) before the PhilHealth's prosecution department.
The alleged violations include the submission of padded claims, misrepresentation, and violation of the PhilHealth warranties of accreditation.
The violations are grounds for the non-renewal or revocation of accreditation of doctors and hospitals and the imposition of a fine from P10,000 to P50,000. Criminal charges for falsification of documents and estafa could also be filed against the respondents.
Padilla said in a text message that the signing of the agreement will give PAO "teeth to police our ranks."
PAO has earlier has earlier decried the manner of getting patients by using recruiters-agents or "seekers" as unethical.
PhilHealth paid 19,145 cataract-related claims reaching around P390 million to hospitals and doctors in Western Visayas from January 2004 to June 2007, according to data from PhilHealth's Corporate Planning Department.
These include P66,989,720 in 2004 (3,477 claims), P123,516,910 in 2005 (6,203 claims), P140,241,210 in 2006 (6,538 claims) and P58,885,130 from January to June this year (2,927 claims).
Last year, it paid P48,491,030 in professional fees alone to 10 doctors in Western Visayas for eye-related operations.