Rep Defensor seeks plunder raps vs PhilHealth officials over alleged mafia scheme

Anakalusugan party-list Representative Mike Defensor has called for plunder charges against PhilHealth officials implicated in an alleged "mafia" scheme.

Senate Majority Leader Juan Miguel Zubiri bared that members of this alleged "mafia" in PhilHealth are conniving with private health care institutions (HCIs) to defraud the state insurer.

Zubiri cited insider information that the group was involved in anomalous transactions concerning the state-run insurance firm.

The fraudulent schemes include HCIs making claims for deceased or non-existent patients, and alleged upcasing and fabrication of illnesses to charge PhilHealth heftier amounts.

Defensor had previously pointed to a suspicious increase in claims for various illnesses and medical procedures as evidence of this scheme.

He explained that the Benefits Claim Committee at the regional level, coupled with the case rate setup, allegedly allows for immediate claim processing and payment, leading to substantial government losses.

Zubiri noted that these schemes are less likely to occur in public institutions due to the presence of the Commission on Audit (COA).