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Some hospitals paid P1K to ‘fake patients’ to bloat PhilHealth claims —Zubiri
Senate Majority Leader Juan Miguel Zubiri alleged that some hospitals are committing fraud against PhilHealth by using fictitious patients to claim exorbitant amounts.
Zubiri shared an anecdote where a patient told inspectors they were out feeding pigs when their bed was found empty.
He explained that investigators found empty patient beds during surprise visits, with hospital staff giving absurd excuses for the patients' absence.
Additionally, Zubiri revealed that some healthcare inspectors allegedly bribe fake patients with P1,000 to facilitate fraudulent claims.
Another fraudulent practice mentioned is 'upcasing,' where patients with mild hypertension are treated as having mild strokes to inflate claims to PhilHealth up to P25,000.
PhilHealth officials present at the hearing had not yet commented on these allegations as of posting time.
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Anakalusugan party-list Representative Mike Defensor has called for plunder charges against PhilHealth officials implicated in an alleged "mafia" scheme.
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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.
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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.
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Presidential Spokesperson Harry Roque found the testimony of former PhilHealth anti-fraud legal officer Thorsson Montes Keith convincing, alleging that a "mafia" within the agency may have stolen approximately P15 billion.
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Senator Juan Miguel Zubiri revealed that an 18-bed hospital in Davao del Sur, Golingay General Hospital, received P10 million from PhilHealth.
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