BATANGAS CITY — The Philippine Health Insurance Corp. (PhilHealth ) has intensified its awareness drive against fraudulent transactions in members’ health insurance benefits and claims.
In a report Friday, PhilHealth Acting President and CEO Dr. Roy Ferrer thanked participants to the first ever Regional Multi-Sectoral Fraud Awareness Forum the agency hosted at PonteFino Hotel Tuesday (June 26) in a bid to eradicate insurance fraud perpetrated by an unscrupulous person or group out to victimize PhilHealth members or the programs of the health insurance agency.
“Kailangan po namin ang kooperasyon ninyo upang maiwasan at mapaigting ang laban sa healthcare fraud at mapangalagaan ang karapatan ng mga miyembro (We need your cooperation in order to avoid fraud and intensify our fight against healthcare fraud as we look after the welfare and uphold the rights of the members),” Ferrer said.
He also assured members and participants that the national health insurance agency is “financially stable and sound” as it also ensures quality services to the members.
With Ferrer were PhilHealth Regional Vice President Paolo Johann Perez and other PhilHealth officials.
Delio Aseron, head of PhilHealth’s Corporate Action Center (CA) and deputy spokesperson said CAC handles queries, feedback and complaints on violations by the healthcare institutions, professionals and PhilHealth personnel.
The forum tackled cases of deceit through “selling the signature, document or even forging one’s signature for a price like any member who is induced to sign a document to attest that he/she has been confined in the hospital for an illness.
As part of the usual process, the document is submitted by the hospital to PhilHealth to claim for a refund as part of the rip-off.
PhilHealth officials also cautioned members of the alleged marketing strategy by a medical center or hospital, devious person or a group luring member-patients who are scheduled for treatment of operation.
Another fraud happens when “bogus” medical services or supplies are added so these could be charged to the patient member and PhilHealth even if these were actually not availed of, thereby increasing the hospital bill other than those covered by PhilHealth.
The officials said these frauds would result in depriving PhilHealth members the proper benefits under the National Health Insurance Program and would even lead to members’ mistrust on the health insurance agency’s capacity to provide the appropriate benefits.
They also explained to members to check with the PhilHealth website on the case rates and the corresponding coverage benefits and the “No Balance, No Billing policy” for indigent, sponsored and “kasambahay” PhilHealth members.
Arturo Alcantara of the agency’s Task Force Health Informatics expounded on the e-Claims, Fraud Prevention and Control like checking the bill or statement of account before being discharged from the hospital.
Forum participants were also advised not to sign a blank claim form or lend their PhilHealth ID or Member Data Record to anyone. (Maroe T. Genosa/PNA)
