Zubiri details how PhilHealth losing millions due to fraud

Christian V. Esguerra, ABS-CBN News

Posted at Aug 11 2020 02:55 PM

Senate Majority Leader Migz Zubiri attends the Senate's session Monday, May 4, 2020, after a two-month break. Henzberg Austria, Senate PRIB

MANILA--A doctor was allegedly asked to cough up P7.3 million in grease money while certain hospitals fielded ghost patients and padded claims, squeezing millions of pesos out of the Philippine Health Insurance Corp. (PhilHealth), Senate Majority Leader Juan Miguel Zubiri said Tuesday.

Zubiri identified at least 5 schemes used by some hospitals to defraud the state-run health insurance firm over the years, including cases where they allegedly paid people P1,000 each to pretend as patients "to claim for more serious ailments."

Some patients were sent home after receiving paracetamol but hospitals invented a more serious illness and sought reimbursement for room and medicines using their names, he said.

In another example of "upcasing," some hospitals merely provided patients with Losartan for hypertension, but allegedly sought reimbursement for mild stroke amounting to P25,000 per claim.

Zubiri said there were also hospitals getting as much as P100,000 weekly by collecting from PhilHealth using 3 to 4 ghost patients.

"Pagnanakaw talaga ito," he said as senators resumed investigation into alleged corruption in the agency. 

"This is no other than blatant fraud and corruption, which is utilising the funds and the money that should go to the proper patients that need our help."

Zubiri cited the case of a doctor who allegedly admitted in a 2016 PhilHealth board meeting that he had been asked to shell out P7.3 million so his clinic could reimburse claims amounting to P73 million for cataract removal surgeries.

He asked the Senate to invite Dr. David Gosengfiao of the Pacific Eye Institute in the next hearing to detail his experience with PhilHealth.

Zubiri also called attention to the case of a certain Pamela del Rosario and her parents who were allegedly used by a Region 1 hospital as ghost patients to claim P1.7 million.

But no case has been filed against the hospital's officials, he said.

"Paano natin mauubos ang katiwalian sa Philhealth kung wala namang kaso na pina-file at walang tao na kinukulong dyan sa Loob ng PhilHealth?" he said.