Whistleblowers expose PhilHealth fraud schemes

Two anonymous whistleblowers have exposed fraudulent schemes perpetrated by PhilHealth officers and employees during the initial investigative hearing of the Department of Justice's Task Force PhilHealth.

The whistleblowers, formerly associated with PhilHealth, detailed how some agency personnel colluded with doctors, hospitals, and banks to execute these fraudulent activities across both central and regional offices.

Alleged fraudulent acts include the processing of false claims, malversation of premiums, and the misuse of the case rate system and the interim reimbursement mechanism.

Abuses and deficiencies within PhilHealth's Legal Department and Information Technology office were also cited as factors enabling the proliferation of these schemes.

The Task Force PhilHealth, established by the National Bureau of Investigation, is set to conduct a financial audit and lifestyle checks on PhilHealth officials and employees as part of its investigation.