'Anti-fraud measures in place,' PhilHealth exec assures
The Philippine government's national health insurance program dubbed PhilHealth is off to achieve its promised universal coverage. As such, efforts to insure at least 85% of the country's 89 million population will be strengthened with new program packages.
While at it, anti-fraud measures will be intensified, acknowledged as among the priorities of new PhilHealth President and Chief Executive Officer (CEO) Dr. Rey Bondoc Aquino.
Dr. Aquino was in town and spoke on the matter with local media present. This, as PhilHealth regional office 6 facilitated the dialogue with the region's stakeholders both in government and private sector.
Dr. Aquino and PhilHealth First Vice President Tito Mendiola in a "guess-timate" placed the program's losses at P720 million or 4% of last year's P18 billion reimbursements.
Mendiola is also the current Area Head for North Luzon and the National Capital Region.
PhilHealth according to Dr. Aquino faces the challenge to fully insure three strategic groups – the poor and indigent who are covered under government-sponsored program, the "informal" sector and Filipino overseas workers.
"There are a lot of things to be done... we are also thinking of decreasing the processess and requirements... we also want our regional offices to have their own places and with clear timetables," Dr. Aquino said while stressing how the poor remains "of primordial importance."
As for fraudulent-claims issue hounding PhilHealth, the new CEO assured that "measures are in place."
"We have our legal department and anti-fraud units who are out to review and validate claims... cases are filed and suspension of accreditations for hospitals and doctors are done," he said. No exact figures on current fraudulent claims was released though.
Relatedly, Dr. Aquino said suspension orders for Bacolod City's Our Lady of Mercy Hospital found guilty of several counts of fraud stands and is executory.
"The suspension is done, fines ordered while management submitted Motion for Reconsideration... pending such, the order for suspension should be executory," Dr. Aquino clarified amidst information that hospital management made public pronouncement on the contrary.
Similar sentiments from PhilHealth Senior Vice President for Operations Ernesto Beltran.
Beltran on the issue of fraud said anything out of ordinary, "claims that deviate to what is normal" are automatically studied now.
"So this stern warning... we are not sleeping on our jobs... we know what is happening in the field," Beltran said.
The PhilHealth meeting saw Western Visayas governors Victor Tanco of Capiz and Felipe Nava of Guimaras and regional directors of various national government agencies.
PhilHealth Regional Office 6 chief Alberto Manduriao for his part reported of positive gains in this year in terms of membership and claim processing.
Manduriao said the region is confident of meeting the target "or even exceeding it."