PhilHealth says 21 cases filed vs. neurologist in alleged claim fraud

The Philippine Health Insurance Corporation has filed 21 cases against a neurologist in South Cotabato for supposedly committing fraud by charging bogus medical bills of PhilHealth members.

The state-run health insurer’s regional office denied allegations of having been in connivance with the doctor.

“We have found probable cause against the erring doctor,” Shirley Domingo, PhiHealth vice president  for corporate affairs and spokesperson, said in a statement.

At least 21 cases of misrepresentation and breach of warranties of accreditation and performance commitment have been filed against Dr. Dennis Menguita.

Domingo said PhilHealth also filed charges against other individuals found to have committed  fraudulent acts—which include soliciting from patients, furnishing false and incorrect information, and falsification of public documents.

“We will leave no stone unturned until all those who abuse the program are punished with the full force of the law. We assure our stakeholders and the general public that this matter has been the subject of non-stop investigation since last year when the fraudulent acts were first discovered,” she said.

PhilHealth Region 12 denied that they were in connivance with Menguita on allegations of using “recruiters” for PhilHealth members to feign illness.

“We are not in connivance with any medical professional or hospital for that matter. In fact, we have taken actions on the hospitals and professional concerned, and there are pending investigations as well as filed cases against violators of the National Health Insurance Act,” it said in a separate statement.

It urged anyone who has direct knowledge or proof that will lend credence to allegations of connivance to bring it out.

“We welcome and we will submit to an investigation in case there is reason for us to be investigated,” it said.

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.

Senate President Vicente Sotto noted during deliberations on the 2019 budget of the Department of Health that the matter was brought to his attention.

“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,” he 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 added. —VDS, GMA News