PhilHealth probing 'upcasing' of hospital admissions to COVID-19, says spox

The Philippine Health Insurance Corp. (PhilHealth) said Thursday it is looking into cases of "upcasing" committed by hospitals and healthcare providers amid the COVID-19 pandemic.

Upcasing, according to PhilHealth spokesperson Shirley Domingo, is when a person confined in a hospital is tagged as a COVID-19 case to get larger reimbursements from the state health insurer.

"Minsan ubo't sipon lang, or ibang sakit na na-hospitalize siya, tapos ginagawa siyang COVID para mapataas ang nakukuhang reimbursement galing sa PhilHealth," she told Unang Balita.

(Sometimes it's just cough and cold and yet they report it as COVID to get higher reimbursements from PhilHealth.)

Domingo said PhilHealth's legal division is already looking into reported cases of upcasing.

She said the hospitals will be given due process during the investigation.

"May process 'yun, tinatanong ang ospital to explain, hini-hear po iyon [There is a process, the hospital will be asked to explain, there is a hearing]," Domingo said.

If proven that the hospital or healthcare provider committed upcasing, its PhilHealth accreditation could be revoked or suspended, she added.

"Depende 'yan sa magiging decision [ng legal division]," Domingo said.

(It will depend on the decision of our legal division.) —KBK, GMA News