Solon alleges fraud in upcasing of hospital admissions to COVID-19

Some patients may have been confined in hospitals and tagged as probable coronavirus disease 2019 (COVID-19) cases as part of an upcasing scheme to get larger reimbursements from the Philippine Health Insurance Corporation (PhilHealth), House Deputy Minority Leader Stella Quimbo alleged on Friday.

According to Maki Pulido’s report on “24 Oras,” Quimbo pointed out that the number of PhilHealth claims for reimbursement of hospitalization of COVID-19 patients exceeded the number of patients admitted in hospitals.

“’Yung tinawag na upcasing, ibig sabihin may sipon ka lang or may ubo pero pipilitin kang ma-admit ka na lang kasi, anyway, mag-overnight ka lang dito. Because of that, makakakuha ka na ng case rate from PhilHealth for, let’s say, mild pneumonia,” Quimbo said.

The case rate for probable COVID-19 cases is between P43,000 to P300,000.

According to Quimbo, this could have been achieved through coordination between the hospital, the regional PhilHealth office, and the national PhilHealth office.

“Talagang hindi ko mapi-pinpoint exactly kung sino ang salarin. Ang alam ko lang is where fraud happens so there has to be some form of collusion in both levels, national and regional, and of course the hospitals,” she said.

Amid the crisis in PhilHealth, Quimbo proposed the Social Insurance Crisis Act which aims to privatize several PhilHealth operations including IT system, litigation, and actuarial services. — Joahna Lei Casilao/DVM, GMA News