Docs welcome probe on fraudulent cataract claims
Private hospitals in Western Visayas and the national organization of ophthalmologists have called on the Philippine Health Insurance Corp. (PhilHealth) to fast-track its investigation on alleged irregularities on claims by doctors and hospitals
The Western Visayas chapter of the Private Hospitals Association of the Philippines (PHAP) said they welcomed the investigation on alleged padded claims and irregularities in claims for cataract operations. But also called on the government insurance system to pinpoint and punish those found liable.
"Go for the jugular," Dr. Elmer Pedregosa, president of PHAP in Western Visayas chapter, said in a telephone interview.
The PHAP has around 20 members in region with at least 3,000 hospital beds.
The Philippine Academy of Ophthalmologists (PAO) also welcomed the investigation and the issuance of an order stopping payments for claims on cataract operations done through medical missions and through recruitment schemes. The order covers all claims starting November 1 this year.
"The general reaction of the members of the PAO is relief that PhilHealth has taken its stand. It's about time. We should make sure this sees itself to completion so that there will be true reforms," said PAO national president Dr. Ma. Dominga Padilla.
Padilla in an earlier interview had criticized PhilHealth for "sitting" on complaints that they have filed for the past several years.
Pedregosa said hospitals are concerned with the recent PhilHealth order stopping all payment for cataract operations done through medical missions because all hospitals will be affected. He said PhilHealth members comprise 60-70 percent of patients of big hospitals.
But he said most of the hospitals will not be affected by the order because cataract claims are not the bulk of their PhilHealth claims.
He said reports that some hospitals and doctors have been earning hundreds of millions of pesos from cataract operations are "really unusual."
"We don’t get that much in cataract claims... not in droves and involving multi-million pesos," said Pedregosa.
PhilHealth data showed that the government insurance corporation paid 19,145 cataract-related claims reaching around P390 million to hospitals and doctors in Western Visayas from January 2004 to June 2007.
Last year, PhilHealth paid P78,411,289 to 10 hospitals in the region for eye-related claims. The Bacolod Our Lady of Mercy Specialty Hospital received the biggest payment reaching P46,736,765.41.
PhilHealth also last year paid P48,491,030 in professional fees to 10 doctors in Western Visayas for eye-related operations.
Lawyer Jay Villegas, manager of the PhilHealth's Fact-Finding and Administrative Investigation Department, earlier said that two hospitals and two doctors in Western Visayas are being investigated for possible abuse of the insurance system. He, however, had declined to identify the doctors and hospitals saying this might pre-empt their findings.
But Pedregosa said all hospitals in Western Visayas are affected by the controversy.
"If the suspected hospitals are found to be liable, let them answer for that. Do not make general policies that put all hospitals in a bad light," he said.
Pedregosa also lamented that the investigation has taken a long time noting that complaints are reports irregularities surfaced since 2005.
"Others who are not doing anything wrong are affected," said Pedregosa.
He said they hope that clear policies and guidelines should be issued to prevent the irregularities.