Alarm up in WV as PhilHealth probes rising cataract-case claims
Alarm has been sounded off in the regional office of the Philippine Health Insurance Corporation (PhilHealth) following yesterday's public disclosure of over P4 billion in feared government loses to dubious and fraudulent claims.
Dubbed by PhilHealth Vice President Madeleine Valera as a "medical cancer, medical malady and a systemic disease," culprits appear to be a number of doctors who are acting in cahoots with "runners" and "agents."
In Western Visayas, PhilHealth Officer-in-Charge Alberto Mandurriao confirmed to The News Today (TNT) that concern run high here in the huge increase of Cataract-case claims particularly in Negros Occidental.
Calling it "unusual," Mandurriao said an investigation was ordered to validate and verify the "disturbing" case claims saying it is possible that is where the bulk of the purported P4 billion loses was based.
"It is not clear right now where the figure (referring to the P4 billion loses) is based," he explained. "But with the cataract case claims mentioned, it is true that we also find it highly unusual here in the region."
Thing is, Officer Mandurriao added, the claims appear to be legitimate and well within the guidelines set by PhilHealth. What raises the suspicions and doubts are the manner of recruitment and enlistment of the PhilHealth members.
Independent investigation made by TNT disclosed longtime operation of at least two foundations subject of PhilHealth probe for months now. The modus operandi, TNT gathered from civilian tipsters was through a barangay-based recruitment of foundation agents who in turn facilitates for a fee the enlistment of potential Cataract-surgery patient to PhilHealth insurance coverage. Passed off as a totally free service of the foundation, membership premiums are shouldered by the foundation itself and after a waiting period of some three months, the member-patient becomes eligible for Cataract-surgery. A foundation-preferred doctor will then conduct the Cataract-surgery or removal and charges professional fee and related medical expenses to the maximum allowed claim.
In Iloilo City, most PhilHealth reimbursements on Cataract-case claims are within the P11,000 range.
Yet loses or not, PhilHealth operations in Western Visayas remains "good," Officer Mandurriao added saying with some P1.1 million direct members on record, PhilHealth was able to pay over P1.2 billion in reimbursements last year.
"We are growing," he said.
PhilHealth as designed by the government is a "premier government corporation that ensures sustainable, affordable and progressive social health insurance which endeavors to influence the delivery of accessible quality health care for all Filipinos."
It pushes for a universal medical coverage while ensuring a better benefits to members and their beneficiaries at affordable premiums.