MANILA – The Philippine Health Insurance Corp. (PhilHealth) on Monday denied losing around P100-billion due to alleged overpayments in light of the “ghost” dialysis scandal.
PhilHealth deputy spokesman Rey Baleña said the amount proceeded to the case rates payment system, where the agency was paying hospitals a set rate for a particular disease.
“Under that system, hospitals can earn profits can also incur losses in a case-to-case basis,” Baleña said.
“We really stand by our system that it’s not overpayment. It’s efficiency gain,” he added.
Baleña said the alleged “ghost” claims were a loophole for PhilHealth, since the agency has no way to verify if a member was still alive unless it was reported to them.
“Dapat maintindihan natin na kung hindi mai-report sa PhilHealth that a member already died, wala kaming way to update our database that the patient has already expired,” he said.
President Rodrigo Duterte on Saturday said he would “reorganize” the government health insurance firm as he noted the loss of some P100-billion was “totally, totally unacceptable.”
Corruption allegations against PhilHealth surfaced after a former employee of a dialysis center in Quezon City came forward to reveal a “ghost dialysis” scheme used to make fraudulent claims to the government health insurance firm. /PN
