P249.7M worth of claims to remove ‘ingrown nails’? Senate panel flags PhilHealth overpayments

Katrina Domingo, ABS-CBN News

Posted at Aug 25 2020 11:42 PM

MANILA - The Senate Blue Ribbon Committee on Tuesday said several PhilHealth regional offices released a total of P249.70 million spanning 4 years for claims linked to removing ingrown nails and other foreign objects from infected skin.

According to the investigating panel's report, from 2014 to 2018, the following PhilHealth regional offices released these amounts for the "debridement of eczematous or infected skin":

  • PhilHealth MIMAROPA: P106.89 million
  • PhilHealth SOCCSKSARGEN: P89.64 million
  • PhilHealth CARAGA: P53.16 million

"'Yan yung mga ingrown [nails]," Senate Blue Ribbon Committee chair Richard Gordon said in an online press conference.

(That's referring to ingrown nails.)

The report did not indicate how many people applied for PhilHealth reimbursement for the specific procedure.
There was also a "suspicious" number of patients with diabetic ketoacidosis in the Davao region, as PhilHealth disbursements for the treatment of the disease was pegged at at least P80 million from 2014 to 2018, he said.

Services for cataract, pneumonia, diabetes and cesarean childbirth have also been the source of fraudulent claims, according to the report.

According to the committee report, PhilHealth disbursed P68.65 billion for 4.76 million pneumonia patients from 2014 to 2020, but DOH data showed there were only 2.44 million cases of pneumonia in the country from 2015 to 2020.

Claims for cataract treatment and operation also reached P17.35 billion in a decade, with 1 million Filipinos allegedly availing of the service.

PhilHealth priced each cataract claim at P16,000, while pneumonia patients allegedly received P15,000 each, the report said.

PhilHealth also released P38.62 billion from 2011 to August 2020 for cesarean births, saying "C-Section comprised 47 percent of all claims for deliveries."

But the Senate Blue Ribbon Committee noted that data from the Health Insurance Data Analytics Committee showed that claims for cesarean births were only pegged at "less than 20 percent."

But the "most rampant fraudulent scheme so far is upcoding or upcasing of case rates" in hospitals across the country, according to the investigating panel's report.

The report noted that while the Borongan Doctors Hospital in Samar only has 40 beds, the facility received "its billings to PhilHealth amounted to P50.16 million just in one year."

The 20-bed Oras Doctors Hospital in Eastern Samar, meanwhile, got P43.42 million from the state-run insurance firm, it said.

"Corruption has been allowed to take over the agency because of poor leadership... There is no vision, no continuity and no punishment for the wicked," Gordon said.

The Senate Blue Ribbon Committee has recommended the immediate removal of all PhilHealth regional vice presidents from their posts, and urged the executive department to subject all officials of the state-run insurance firm under "regular lifestyle checks."

The Senate is expected to released a separate report on its investigation into the alleged misuse of COVID-19 funds and the attempted overpricing of equipment for PhilHealth's modernization program.