Friday, September 24, 2021

Benefit claims ‘screened properly’ to prevent fraud

THE Philippine Health Insurance Corp. (PhilHealth) 7 assured the public of proper screening of benefit claims following reports of fraudulent transactions.

The PhilHealth 7, in a statement on Sunday, Sept. 13, 2020, said it has reached out to authorities in verifying possible cases of fraud — hospitals allegedly taking advantage of the PhilHealth’s benefit payment by making a non-Covid-19 case appear as one to let a patient claim higher benefit coverage.

The agency’s press release is a delayed response to the statement made by Gov. Gwendolyn Garcia. The video aired by Sugbo News in late July this year was entitled “I just hope that we will be honest about things.”

In the video, Garcia cited cases of alleged anomalies involving coronavirus disease (Covid-19) claims in the Province between the hospital and PhilHealth 7.

The governor also asked to segregate cases of deceased patients who died solely because of Covid-19 infection and incidental deaths because of the presence of co-morbidities.

For its part, the PhilHealth 7 cited an investigation report from the Criminal Investigation and Detection Group (CIDG) 7, which it received last Sept. 10.

The state-run health insurer cited the CIDG 7 report on an incident in Carmen, Cebu where a person was hospitalized due to stab wounds. The report stated that “the victim died instantly due to multiple stab wounds but was not admitted to the hospital and did not undergo RT-PCR (real-time polymerase chain reaction) test.”

The CIDG 7 report further stated that “for the same period, (the health care institution) nearest to Carmen, Cebu has admitted nine patients of stabbing incidents. Accordingly, all the victims were subsequently released from the said infirmary after given appropriate medication without subjecting for RT-PCR test.”

The PhilHealth 7 assured the public that claims received from accredited health care institutions are duly reviewed by medical doctors in the Regional Office’s Benefits Administration Section even before this pandemic.

Claims with incomplete requirements or discrepancies are returned to hospitals for compliance, while claims determined to be invalid due to an absolute deficiency or unmet requirement are denied.

As of Aug. 31, 2020, the PhilHealth 7 had already paid a total of 515 in-patient Covid-19 claims amounting to P109.9 million in total and P32.6 million for 6,141 claims on RT-PCR testing.

As of the same date, there were 359 claims which were returned to hospitals, while 65 were denied. (WBS with PR)


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