RED FLAG UP
2 hospitals, Ilonggo docs in Philhealth 'watchlist'
Government's Philippine Health Insurance Corporation (PHIC) has now publicly disclosed strengthened and widened investigation on significantly huge claims of cataract cases in Western Visayas.
With nearly P400 million in paid-up claims in three and a half year period, questions abound on the regularity and legality of the 'cataract-scenario' here dubbed as "of epidemic-proportion."
Government concern is up on possible padding of hospital charges and billings and the actual conduct of medical professionals feared to have ripped-off the government with millions in unjust claims.
For now, operation of at least two private hospitals and two Ilonggo doctors are eyed for criminal charges and offenses. However, The News Today (TNT) in an independent investigation gathered the names of some four other eye specialists even as PHIC probers widened the list of 'targets' to just about all practicing Ophthalmologists in Region 6.
Atty. Jay Villegas PHIC's chief of the Fact-Finding Investigation and Administrative Department was sent to Iloilo yesterday to personally oversee the validation of evidences gathered from unsuspecting patients. This, as he acknowledged a "Hospital watchlist" with a "red flag" on claims of all eye doctors here.
As such, professional fees of the group and billings of partner hospitals will be scrutinized alongside the case build-up. The liabilities, if any, will equally fall on both with Atty. Villegas assuring of PHIC action to protect government's interests and millions in PHIC funds.
"Give us time," Villegas appealed while stressing that PHIC pushes for institutionalized reforms and "wants to get to the bottom of all these."
No particulars were released on the subject hospitals and doctors as Villegas expressed concern on premature disclosure that might affect the PHIC investigation.
TNT was told that random check made by government probers confirmed fraudulent claims in ten out of the 50 initially-checked cases. Interestingly enough, all ten point to same two Ilonggo eye doctors and two private hospitals.
Another case was also disclosed where a woman complainant called for PHIC action on the death of her 75 year-old father. The eye doctor involved and the hospital is again the same as in the "watchlist."
"We call on the public to report suspected abuse and fraud to the nearest PhilHealth office. And this appeal to our doctors and hospitals to follow our established rules and regulations," Villegas added.
Controversy surrounded the cataract cases here following questions raised by Iloilo First District Representative Janette Garin during the budget hearing of the Health Department in Congress.
Health Secretary Francisco Duque admitted to the "shenanigans" while vowing to minimize if not curb the incidents.