PhilHealth reiterates warning against health insurance fraud

State health insurer, Philippine Health Insurance Corporation (PhilHealth) strongly advises health care providers not to engage in unethical acts such as upcasing of claims.

The Agency received various reports relating to health care providers colluding with patients to declare minor respiratory symptoms as COVID-19 case for higher benefit reimbursements.

In view of the increase in reports of claims manipulation, state health insurer urges patients and their families to directly report such illegal acts to PhilHealth.

The Agency is likewise calling on the public to be vigilant of such acts and fully cooperate with PhilHealth by providing proofs to support the investigation.

“We call on the public to cooperate with us to immediately curtail these wrongdoings.  We should protect the National Health Insurance fund, because it is a public fund, it is your money,“ PhilHealth President and Chief Executive Officer Dante A. Gierran said.

PhilHealth assures whistleblowers that complete confidentiality of reports as well as their protection will be given as provided by law.

To further strengthen its campaign against unlawful acts, PhilHealth has earlier initiated collaborations with the National Bureau of Investigation to detect, deter, and prosecute fraud committed by hospitals and professionals.

The state health insurance chief stressed that he will not tolerate deceitful practices made by some providers in order to take advantage of the uncertainties brought about by the pandemic.

PhilHealth shall not hesitate to use full force of the law to those caught engaging in these illegal practices,” he said.

The public may send their reports pertaining to these fraudulent acts through email at [email protected][email protected]; and [email protected] or by mail addressed to the Office of the Corporate Secretary, Room 1711, 17th Floor Citystate Centre, 709 Shaw Blvd., Pasig City