At least four hospitals in the region are under investigation for padding their claims, a Philippine Health Insurance Corporation (PhilHealth) executive said.
Filbert Bryan Sollesta, PhilHealth Field Operations Division Chief, said they are now finishing the fact-finding investigation on the hospitals that are doing the so-called “upcasing” practice.
Upcasing is a claim fraud in which the hospitals pad their claims and therefore collect higher reimbursements. A hospital can ‘upcase’ a simple cough or cold by making a false claim for pneumonia so they collect higher reimbursable amounts from PhilHealth.
Sollesta refused to name those under investigation, but said they are all “tertiary.”
He said they are reviewing 2,000 suspected upcasing cases.
Sollesta said a there is also a hospital in Davao del Sur that wasn’t given accreditation by PhilHealth due to “patient seeking.”
Patient seeking is a practice that a hospital would find “patients” and admit them to the hospital, even if it is not necessary, to gain profit.
Before the Universal Health Care Law, PhilHealth was able to close several hospitals for fraud and now they are investigating to hold hospitals accountable for their misdemeanors.
The PhilHealth is urging the public to file a complaint if they experience such illegal activities from hospitals so that they can take action against it.
