PhilHealth probes P680K fraud claims in CAR

The Philippine Health Insurance Corp. (PhilHealth) is investigating approximately 1,000 fraudulent claims in the Cordillera Administrative Region (CAR) involving benefits already paid to healthcare providers for treatments never received.

These cases, which occurred between 2022 and 2024, include claims for patients who had already passed away and instances of double billing for services.

The total amount of benefits disbursed for these questionable claims is estimated at P680,000.

Some of these fraudulent claims were uncovered when actual PhilHealth members received text alerts for services they did not avail themselves of.

PhilHealth has intensified its monitoring efforts, employing methods like surprise facility inspections, home visits for claim validation, and real-time text notifications.

Healthcare facilities found to be involved in fraudulent activities will face penalties such as fines or suspension of their accreditation after undergoing due process.