Philhealth charges 4 docs, 3 hospitals in cataract mess

The Philippine Health Insurance Corp. (PhilHealth) lodged administrative cases against four doctors and three hospitals in Western Visayas over irregularities in insurance claims for cataract surgeries. Online news site The News Today quoted a Philhealth official as saying that the doctors and hospitals face 34 counts of violating the National Health Insurance Act. Jay Villegas, PhilHealth fact-finding and administrative investigation manager, said the alleged violations include the submission of padded claims, misrepresentation, and violation of the PhilHealth warranties of accreditation. While he declined to identify the doctors and hospitals that have been charged, he said these were the same ones who submitted the highest claims for cataract surgeries. PhilHealth records showed it paid 19,145 cataract-related claims reaching around P390 million to hospitals and doctors in Western Visayas from January 2004 to June 2007. These include P66,989,720 in 2004 (3,477 claims), P123,516,910 in 2005 (6,203 claims), P140,241,210 in 2006 (6,538 claims) and P58,885,130 from January to June this year (2,927 claims). Last month, PhilHealth ordered a stop to payment of claims for cataract surgery during medical missions and through recruitment schemes amid reports of irregularities in claims. The reported violations, first reported in 2004, involved complaints that the hospitals and doctors padded their claims to include medicines and services not availed of by patients. Doctors performing these cataract operations are also earning millions of pesos from PhilHealth, the office said. In 2006 alone, PhilHealth paid P48,491,030 in professional fees to 10 doctors in Western Visayas for eye-related operations. - GMANews.TV