The revelation of Philippine Health Insurance Corporation (Philhealth) officials that fraudulent claims continue to hound the state-run health care institution is something that must not be dismissed.
In a press briefing held for purposes of educating the public about the newly-implemented Universal Health Care Act, a new law that practically grants all Filipinos with health care benefits, (Philhealth) officials confirmed that it is looking into about 2,000 claims from four tertiary hospitals that were suspected to be fraudulent.
In these claims, the suspicion was that the hospitals were involved in “upcasing,” the act of upgrading a simple illness into a complicated one so that the hospitals involved could raise their claims much higher than the claims for the simple cases.
Last year, another hospital in Davao del Sur was found to be “patient seeking,” prompting the institution to suspend its accreditation.
In the past, there were reports of collusion between employers and hospitals to milk the health care program, then managed by the Philippine Medical Care Commission, where employees were made to sign forms as if they were admitted in the hospitals and that the claim proceeds were divided among the employees, their employers and the hospitals.
At present, under the Universal Health Care Act, such collusions are penalized and that those behind them are not just administratively liable but criminally guilty as well.
However, it seems that those that have committed these malpractices either have not learned or have refused to learn the lessons. Others must have followed these erring entities for the simple reason that they thought they could either get away with their criminal acts or that the penalty was very light.
It is time to intensify the investigation on those suspected to be erring hospitals and employers and that penalties must be raised so that lessons can be learned.
As always, lessons are learned the hard way.
