Manila: A government-run health insurance company began investigating allegations that hospitals and doctors have been collecting benefits for treating patients who are well and have been paid to act sick, a senior official said, adding the government agency will go bankrupt if corrupt hospitals and doctors continue the malpractice.
“The Philippine Health Insurance Corp. [PhilHealth] stopped insurance payments to two private hospitals in northern Luzon and in Mindanao, southern Luzon. They were found admitting well patients for overnight stay. When they were discharged after a day, their medical certificates stated they had pneumonia,” said Minguita Padilla, head executive staff of the health department.
“The erring hospitals allegedly hire staff members to look for people who are willing to act sick for money. Some of the paid-patients were street vendors who were willing to connive with hospitals and doctors,” Padilla said during a weekly health forum in Quezon City on Wednesday.
Hospitals earn millions and doctors additional thousands through the scam that has been unfolding since investigations began early this year, said Padilla.
Recently, six health-care facilities were found to have patients who underwent unnecessary surgery for cataract removal, said Padilla.
Investigations of insurance payments for eye operations began when 90 per cent of patients in middle-ranking eye centres were found to have undergone multiple eye procedures. “This was unusual because in respectable hospitals, only 3 per cent of eye patients go through multiple procedures,” Padilla said.
Philheath will continue investigations of consistently high insurance payments given to patients who allegedly underwent cataract removal, caesarean, haemodialysis, and maternity care, said Padilla.
In 2014, PhilHealth paid P7.6 billion (Dh610 million) for cases of pneumonia; P4.6 billion for haemodialysis; P4.2 billion for caesarean delivery; P2.1 billion for cataract removal; and P1.5 billion for maternity care.
PhilHealth’s insurance payments reached P56 billion in 2013 and P78 billion, or a 28 per cent increase, in 2014. PhilHealth’s insurance payment has averaged P1.7 billion a week in 2015.
“Philhealth wants to know how much of the insurance payments go to corrupt doctors and hospitals,” said an investigator who requested for anonymity.
The Philippine government has been trying to enrol all members of the country’s labour force into Philhealth. Employers shoulder the majority of monthly Philhealth payments for employees. Senior citizens retain their Philhealth’s benefits even if they are exempted from monthly insurance payments.
