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PhilHealth Faces Allegations Of Overpayment That Costed Billions In Losses

PHILHEALTH – Philippine Health Insurance Corporation (PhilHealth) faced allegations of overpayment that costed billions in losses.

Photo taken from Business News Philippines

The government-owned insurance company has been in several reports lately. A recent post revealed PhilHealth tracking down about 8000 fraudulent acts.

Allegations of overpayment done by the health insurance company have been around that also insinuates that the company had lost billions.

To disagree, Rey Baleña – PhilHealth’s deputy spokesman – explained that the company uses a case rates payment system as a basis. Meaning a set rate for certain diseases and corresponding treatments is followed.

In a conversation with ABS CBN News Channel, Baleña explained the mechanics behind the stated system:

“We don’t consider it as overpayment because under the case rates regime that’s the way we pay our providers, the case rates, wherein there are predetermined rates already that we pay for a certain disease or illness or procedure.”

Health centers/hospitals can either “win in some” or “lose in some” according to Baleña in using the system. Basically, whether hospitals can profit from it or lose depends on the case presented.

Baleña maintains his stand on the company’s system, saying:

“We really stand by our system that it’s not overpayment. It’s efficiency gain.”

The company has also been scrutinized recently after a report of “ghost” claimants for dialysis.

But Baleña considered the “ghost” case a loophole in the system since the agency can not really tell if the claimants are dead unless it was reported and verified.

This is according to an article from ABS CBN News.

Last Saturday, President Duterte claimed that he might “reorganize” the health insurance company after stating that the loss of P100 billion is “totally unacceptable.”

The PhilHeath spokesperson refuted the information about the P100 billion amount in losses arguing that recorded loss in PhilHealth data amounts to P300 million.

That is all there is to it, at least for now. We’ll post updates as soon as we got them.

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