Duque to PhilHealth members: Report attempts to involve them in fraud schemes

Health Secretary Francisco Duque III on Tuesday urged PhilHealth members to report to authorities attempts by health care providers to involve them in fraudulent activities.

"Kung meron pong mga tiwali na gusto kayong kakutsaba upang dayain ang sistema ng PhilHealth ay dapat isumbong niyo agad sa hotline ng PhilHealth,” Duque said at a press conference.

"Halimbawa, papapirmahan kayo ng inyong medical records na, ‘Ito ilagay mo yung antibiotic, imbes na 6, 60. Lagyan ng zero'."

Duque also said PhilHealth members may be made to act sick in exchange for a bag of groceries.

The DOH secretary made the appeal amid the controversy involving WellMed Dialysis Center that has put PhilHealth into the spotlight.

According to Duque, there were 7,213 cases filed last year against health facilities, and that he is now investigating how many of these cases involved "ghost" claims.

"The Philhealth is improving its fraud detection, deterrence and also the anti-fraud capacity building within the PhilHealth. It is now being worked on to reduce, if not eliminate, the occurrence of fraudulent claims," he said.

There are presently 99 million PhilHealth members.

Duque said PhilHealth processes 12 million claims every year, or an equivalent of 1 million every month. With this number, he said it is possible that some processed claims may not be fraudulent but may have been approved as a result of an error.

"Gusto natin talagang 100% fraud-proof yung sistema. Pero kahit na papaano, meron ding mga nakakalusot. Pero minsan, talagang error din on the part of those processing in the hospitals. Kaya talagang sinusuyod natin ito," he said. —KBK, GMA News