PhilHealth estimates P10.2 billion lost to fraud in 2019

Philippine Health Insurance Corporation (PhilHealth) president and CEO Ricardo Morales estimates that P10.2 billion was lost to fraud in 2019, a figure that could double by next year if unaddressed.

Approximately 20,000 fraudulent claims are currently under investigation by PhilHealth's legal sector, prosecution, arbitration, and regional offices.

Morales cited database flaws and emphasized the need for a robust IT system and biometric verification to combat fraud.

Presidential Anti-Corruption Commission (PACC) Commissioner Greco Belgica stated that ghost membership, overpayment of medical claims, and other forms of insurance fraud were made possible by a lack of transparency and validation system in PhilHealth.

Belgica noted that PhilHealth's weak IT system, despite billions spent, has remained fragmented, allowing fraudulent schemes to prosper.

The PACC intends to expand its investigation to cover other regions and may file cases against more officials involved in irregularities before the Office of the Ombudsman.