PhilHealth surpasses target goal in Region 12 despite fraudulent claims

The regional office collected P569.3 million from its 127,969 members in 2007, higher by 1.6% from the targeted P560 million, said Ramon Aristoza, assistant vice-president of PhilHealth regional office.
“There have been cases of fraudulent claims in the region but they are not yet alarming. They’re under control,” he said.

Fraudulent claims refer to the practice of health care providers’ manipulation of members’ records to make it appear they could claim benefits.

Jusen Lubaton, regional PhilHealth lawyer, said that of the 215,059 claims received last year, 193 cases were believed to have been fraudulent claims.
“The fraudulent cases were very minimal but we will continue to maintain our watch [to prevent this unscrupulous practice]. All big things start from small,” he added.
The officials, however, did not name the erring hospitals during the press conference over the weekend.

Aristoza said there were more fraudulent claims in the field of ophthalmology particularly in cataract operations, citing the creation of “Task Force Kisapmata.”
Aristoza said that fraudulent claims for cataract extraction were unusually pervasive in the Visayas but a source who declined to be named revealed that such as case may also be happening in nearby General Santos City.
Still, collection trend in the past four years has been on the upswing, he said. In 2004, collection reached P365.5 million, P447 million in 2005, P516.6 million in 2006 and P569.3 million last year, data from the regional office showed.
Benefits paid by the regional PhilHealth office to accredited health care institutions amounted to P1.03 billion, up 28% or P223.07 million from P809.8 million in 2006.
There are 139 PhilHealth-accredited hospitals and rural health units across the region comprising South Cotabato, Sarangani, North Cotabato, Sultan Kudarat and the cities of Koronadal, Cotabato, General Santos, Tacurong and Kidapawan.
Majority of the PhilHealth members in the region were enrolled through sponsorship at 63,061, mostly by local government units or congressional offices.

The year 2007 was an election year.
PhilHealth members coming from the government sector stand at 4,770 and 23,105 from the private sector.
Individual paying members were placed at 26,309 and overseas foreign workers at 9,684. (MindaNews)