PhilHealth finds 'tsinoy' guilty of fraud
For tampering documents of a PhilHealth claim, one city resident was found guilty of fraud thus fined and suspended from the government's National Health Insurance Program (NHIP).
In a news release, PhilHealth Regional Office 6 identified the claimant as Benjamin Chua of Mabini Street, Iloilo City. Chua was ordered to pay P5,000 in penalty and deleted from the roster of PhilHealth members in the next three months.
As such, a warning is out against members on any similar attempts in making false claims lest they suffer the same fate Chua now faced.
Heard by PhilHealth Central Office's Arbitration Department, Health Insurance Arbiter Ma. Lourdes Mendoza established Chua's liability as provided in the NHIP's fraudulent acts. Provisions under RA 7875 otherwise known as National Health Insurance Act states that any member who for purpose of claiming NHIP benefits independently or in connivance with the health care provider shall be accordingly penalized.
The News Today (TNT) gathered that Chua filed a claim for the hospitalization of his wife Reina at the Manila Doctors Hospital back in February 17-18, 2000.
"For the purpose of claiming reimbursement, the respondent member tampered the date of PhilHealth Bank Receipt No. 1439243-A by changing the date of receipt from February 4, 2000 to December 4, 1999," excerpts of the PhilHealth Decision cited. The bank receipt serves as proof of his premium payment to qualify in availing the benefits.
Tampering and alteration of the premium payment from February 2000 back to December 1999 was very material in the case since it will cause the approval or disapproval of the PhilHealth benefit as claimed.
"It is the policy of this Corporation that for a member to be entitled to PhilHealth benefits, it is a requirement, among others, that the latter's contribution for at least three months within six months prior to the first day of the member or dependent's confinement has been paid," the PhilHealth Prosecution cited. "Hence, payment been actually made on the first quarter of 2000 (February 4, 2000) and not in December 1999, the member cannot claim PhilHealth benefit."
Chua in his initial reply denied any tampering while stressing that there was no need to tamper since the same indicates that period covered was 1st quarter of 2000. He however failed to attend subsequent hearing schedules reason why the Insurance Arbiter ruled on the evidence presented by the Prosecution.
It was not immediately clear if Chua will appeal the PhilHealth decision however as provided by law, an appeal is allowed unless the decision becomes final and executory.
(With reports from Larry Tabsing)