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PhilHealth’s Morales: P10.2B could have been lost to fraud in 2019, likely doubled next year

State insurer Philippine Health Insurance Corp. (PhilHealth) could have lost P10.2 billion due to fraud in 2019 and this could double to P18 billion by next year should the issue remain unaddressed, its top official claimed Tuesday.

In a statement before the Senate, PhilHealth president and chief executive officer Ricardo Morales said a study conducted last year found that fraudulent cases comprise 7.5% of the total, which compares with the global average of 10 to 20%.

"I have maintained from day one of my tenure that the main solution to this systematic fraud problem lies in our robust, integrated, and harmonized information management system running a clean, complete, and updated membership database," he said.

"Only such a system can keep track of the 109 million members, the 40,000 accredited healthcare professionals, 8,500 facilities filing 35,000 a day, and paying P2 billion a week," added Morales.

According to Morales, the current information system runs a hundred applications, and a database that handles 370 transactions per second.

It also caters to 4,000 internal and 20,000 external users, distributed among its 130 offices and branches nationwide.

"If the corporation stands to lose tens of billions a year through fraud which can be avoided by information technology, then the alleged overpriced P2.1 billion information technology program over three years appears paltry indeed which is the strategic shift in outlook I would like the organization to adopt," Morales said. — RSJ, GMA News