PhilHealth partners with NBI to combat health insurance fraud

The state-run Philippine Health Insurance Corporation has entered into an accord with the National Bureau of Investigation (NBI) to combat fraudulent health insurance schemes.

In a statement on Tuesday, PhilHealth said its signed a memorandum of agreement with the NBI to go after “illicit activities that are potentially defrauding the National Health Insurance Program.”

The parties have agreed on a shared set of responsibilities to detect, deter, and prosecute fraud committed by health care facilities and professionals, and even those made in collusion with its own officers and employees.

Under the agreement, PhilHealth may request for investigative assistance from the NBI including surveillance, investigation, and entrapment of violators, if needed.

The state health insurer added that PhilHealth officers and employees may be called on as witnesses for complaints to be filed by the Bureau arising from the investigations.

All pertinent records, documents, and information must be turned over by PhilHealth to the NBI to help resolve the cases, it said.

PhilHealth president and CEO Dante Gierran, a former NBI chief, said that the collaborative efforts of both PhilHealth and the NBI would result in a definitive action against fraud that was taken up in Congressional inquiries last year. 

For his part, NBI officer-in-charge Eric Distor said that the MOA with PhilHealth “essentially outlines how the Bureau and PhilHealth will work together as a team in combating graft and corruption and in gaining back the trust and confidence of the people in government-subsidized health care system.”

Distor added that the NBI will “respond swiftly and appropriately to a complaint, relevant tip-off, information, and/or lead provided by PhilHealth whether referred by PhilHealth head office or regional office including its legal offices, to determine possible violations.”—AOL, GMA News