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SENATE
probers were told about what Sen. Richard Gordon
described as “a racket from head to toe” involving
rampant padding and dubious claims by errant doctors and
hospitals, resulting in over P4 billion in losses for
the PhilHealth program.
Appearing at a public hearing by the Committee on
Government Corporations Tuesday, Madeleine Valera,
PhilHeath vice president for health finance policy, said
they uncovered the medical malady after a thorough
review of multimillion-peso claims made by “scalawag”
doctors and hospitals against PhilHealth since 1995.
“We
stumbled into a bigger problem ailing the PhilHealth
program,” said Gordon, committee chairman, adding the
anomaly included billings and claims for procedures
ranging from circumcision to toenail extractions. “The
system is not going to last based on what we saw.”
Asked to
cite other instances, Valera told the committee that one
highly paid doctor, whose name was withheld temporarily,
filed for and was paid P17 million a year in PhilHealth
billings for doing cataract procedures costing P16,000
per eye; toenail extraction, P4,000; and foreskin
removal, P4,000 to P5,000.
Sen.
Juan Ponce Enrile said the doctors and hospitals
involved in the racket must be unmasked and appropriate
legal action taken against them. Enrile added that
Congress may need to revisit the entire PhilHealth
program to plug the yawning loopholes.
Gordon
asked PhilHealth officials to submit documents and other
evidence that would enable the committee to determine
the extent of the racket and craft the remedial
legislation needed to arrest the anomaly.
He added
that there were also reports that some doctors
purportedly conduct free medical missions, then bill
PhilHealth; while some hospitals file falsified claims
for dispensing medicine and doing medical procedure on
patients they enrolled with PhilHealth.
“We have
seen padded claims for ghost patients,” said Valera,
adding that some hospitals also “manufactured claims”
when there were no patients served.
She said
a PhilHealth panel is continuing its review of these
cases in cooperation with the medical society to stamp
out the “scalawags” draining PhilHealth resources, to
the detriment of indigent members. |
