PhilHealth told: If you have proof, file raps vs facilities with fraudulent claims


Posted at May 13 2021 09:30 AM | Updated as of May 13 2021 09:37 AM

Philhealth Local office at Mother Ignacia Street. Quezon City. Taken on June 7, 2019. Mark Demayo, ABS-CBN News

MANILA - A group of private hospitals on Thursday urged state insurer PhilHealth to file complaints against health facilities with fraudulent claims.

PhilHealth earlier launched an investigation into some 15,000 cases of “false claims” filed from 2019 to 2021.

This figure is a "small" percentage of some 3 million claims that hospitals file, said Dr. Jose Rene de Grano, president of the Private Hospitals Association Philippines Inc.

"Sana naman po wag nila lahatin na ang private hospitals ay ganun. Kasi naapektuhan po ang mga tunay na ospital na wala namang ginagawang illegal activities," he told ABS-CBN's Teleradyo.

(I hope they don't brand all private hospitals like that because it affects those that do not engage in illegal activities.)

"Para pong ganun na lang ang ginagawa nila every time na nahihirapan sila, di sila makapagbayad. Kung may proof sila eh 'di kasuhan nila."

(It's what they do every time they can't pay. If they have proof then file charges.)

Based on PHAPI's assessment this month, PhilHealth owes private hospitals more than P28 billion, De Grano earlier said.

The state insurer also pays only 35 percent instead of 60 percent of their claims under the debit credit payment method (DCPM), he added.

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