PhilHealth forms task force to probe spurious cataract claims
The Philippine Health Insurance Corp. (PhilHealth) has created a task force to monitor and investigate hospitals that are currently on its watch list for spurious claims related to cataract operations.
Lawyer Jay Villegas, manager of the PhilHealth's Fact-Finding and Administrative Investigation Department, said government insurance corporation has created Task Force Kisapmata amid reports that some hospitals and doctors have been earning hundreds of millions of pesos through unethical practices and fraudulent claims.
PhilHealth has also ordered a stop to payment of claims for cataract surgery during medical missions and through recruitment schemes amid reports of irregularities in claims of hospitals and doctors involving hundreds of millions of pesos.
The discontinuance of the payments covering all claims for cataract operations with admission dates starting Nov. 1 this year. It has also set a limit to the number of claims for the procedure which may be compensated.
Villegas earlier said two hospitals and two doctors in Western Visayas are being investigated for alleged irregularities in claims related to cataract operations. He had declined to identify them.
The investigation is focusing on alleged padded claims of hospitals and doctors and unethical practices in the identification and recruitment of patients for cataract operations charged to PhilHealth that violate Act 7875 or the National Health Insurance Act.
Violations of the law will be a ground for the non-renewal or revocation of accreditation of doctors and hospitals and the imposition of a fine from P10,000 to P50,000.
He said results of their investigation have been submitted to PhilHealth's prosecution department which will file the appropriate charges against doctors and hospitals found liable.
The Philippine Academy of Ophthalmologists (PAO), which has condemned the recruitment of patients through "seekers", called on doctors in other specialties to also watch their ranks.
PAO National President Dr. Ma. Dominga Padilla said that it would be difficult and painful to have their peers investigated and possibly prosecuted, their objective is for the "greater good.'
"We are doing this to maintain the dignity of the medical profession, uphold the safety of patients and protect the welfare of the PhilHealth," she said in a telephone interview.