Philhealth probes specialist in alleged fraud in South Cotabato

The Philippine Health Insurance Corporation is now investigating a neurologist in South Cotabato, who is allegedly involved in fraud by charging bogus medical bills of Philhealth members against the state-run national health insurer.

During deliberations on the 2019 budget of the Department of Health on Tuesday, Senate President Vicente Sotto III said it was brought to his attention that a certain neurologist in South Cotabato is using “recruiters” who hire Philhealth members to feign illness.

Created in 1995 to implement the country’s universal health coverage, Philhealth is a tax-exempt, government-owned and controlled corporation attached to the Department of Health.

Apart from administering the National Health Insurance Program, Philhealth supervises the provision of health benefits, sets standards, rules and regulations to ensure healthcare quality.

“The modus is, this doctor has recruiters. These recruiters will hire Philhealth members, who will be paid P1,000 each. These members, who are not really sick, will be confined in the hospital to make it appear that they are sick,” Sotto said.

“This doctor will connive with the hospital with which he is affiliated, particularly the St. Louis Hospital, Allah Valley Medical Specialist Center Inc., Dr. Arturo P. Pingoy Medical Center, and St. Louis Medical CL and Hospital in order to collect from Philhealth the supposed expenses incurred by the hired Philhealth members,” Sotto claimed.

Based on Philhealth documents, Sotto identified the medical specialist as Dr. Mark Menguita.

While the reimbursements for medical expenses allegedly go directly to the neurologist, the hospitals also get their share from the modus operandi.

Sotto asked Philhealth what it is doing about the situation.

Senator Joseph Victor Ejercito, the sponsor of the DOH  budget, spoke on behalf of Philhealth, saying  an investigation is ongoing at the regional level.

“According to Philhealth, they will go there personally to check on the status of this case that you have mentioned,” he added.

Sotto also asked what Philhealth is doing in cases of fraudulent claims from hospitals and doctors, noting such cases are not uncommon and unique to the Philippines as there are similar cases in other countries.

For starters, Philhealth conducts and investigation, If the doctors and hospitals involved are found Guilty, they will be suspended and their licenses revoked depending on the severity of the case, Ejercito said.

“Likewise, the doctor that is involved will have his PRC (Professional Regulation Commission) license revoked,” he said. —VDS, GMA News