Dr. Hector Zenon Leonardo Malate, acting regional vice president of Philippine Health Insurance Corporation-Region 12 (Screengrab of live-streamed press conference)
GENERAL SANTOS CITY – The Philippine Health Insurance Corporation (PhilHealth) in Region 12 (Soccsksargen) has endorsed for investigation over 8,000 questionable health insurance claims submitted by various hospitals.
Dr. Hector Zenon Leonardo Malate, acting regional vice president of PhilHealth-Region 12, said Wednesday the concerned claims have been flagged by their doctors and processing personnel due to possible fraud.
He said these are now being processed by their legal department for fact-finding investigation.
“These include double filing of claims and other transactions that constitute possible violations by the concerned hospitals,” he said in a radio interview.
Malate said the investigation of the other fraudulent claims is ongoing and they already forwarded some cases to their central office for decision.
Last month, he said their arbitration office has meted a three-month suspension to the Matias Clinic based in Isulan town, Sultan Kudarat after being found to have submitted claims for non-admitted patients.
He said another hospital and a doctor based in this city have been recommended with the same sanctions by their office for alleged fraudulent practices.
“We’re expecting the final decision to come out by June,” Malate said.
PhilHealth-12 disclosed late last year that it has found at least 25 hospitals and nine doctors in the region to have committed alleged fraudulent practices and submitted questionable insurance claims.
It said most of the violations were for misrepresentation, claiming for non-admitted patients, extending the period of confinement and multiple filing of claims.
Malate said the 8,000 flagged claims are among the 57,965 received by PhilHealth-12 from hospitals in the region as of April 5 that have yet to be settled or paid.
He said 62 percent of these or some 36,197 are still within the 60-day allotted period for the processing and payment to the concerned hospitals.
Some 38 percent of the claims are beyond the settlement period due to pending requirements and policy-related problems, he said. (PNA)
