Senate probes suspicious PhilHealth reimbursements

After reports of alleged suspicious claims of eye centers targeting bigger insurance reimbursements from PhilHealth, the agency is now looking at another fraudulent practice: ‘upscaling’ of pneumonia cases in some hospitals.

 

Testifying before the Senate blue ribbon committee, PhilHealth president and CEO Atty. Alexander Padilla said they paid out the highest reimbursement for pneumonia cases in 2014 amounting to P7.6 billion. 
 

Padilla said that under the modus, checkups for mere cough or sore throat are sometimes upscaled to a diagnosis of pneumonia, to enable hospitals and clinics to claim reimbursement between P15,000 to P32,000, for cases with complications.

In normal practice, Philhealth does not cover cases of simple cough or sore throat, Padilla said.

But Padilla maintained that there is no rampant cases of pneumonia. 

“Otherwise parang may epidemic na tayo lingo-lingo sa mga iba-ibang lugar, na di naman totoo,“ he said.

 

GMA News earlier aired a series of investigative reports on suspicious claims of eye centers and clinics, particularly for removal of cataracts, which ballooned to P2billion in 2014, making it the 4th top procedure reimbursed by PhilHealth.

Several of these reports were shown on Wednesday's hearing to validate PhilHealth's own investigation. — text and photo by Ruth Cabal/RSJ, GMA News