Organized labor wants an inquiry into reports that the Philippine Health Insurance Corp. (Philhealth) is nearing bankruptcy due to widespread fraudulent claims.
Trade Union Congress of the Philippines (TUCP), the country’s largest labor group, said the Ombudsman and the Commission on Audit should also look into the alleged “connivance” between doctors and hospitals to defraud Philhealth.
“There is no telling how much money Philhealth is actually losing now on account of spurious claims. But it is estimated to be easily anywhere from P200 million to P400 million every year,” Alex Aguilar, TUCP spokesman, said.
He said the anomaly was not only robbing workers of their hard earned contributions to Philhealth but was also causing the insurance firm’s financial ruin.
“Our sense is that there are syndicates systematically robbing Philhealth. It is quite possible that they are in cahoots with a number of rotten insiders because in some cases, the phony claims are patently overstated, and yet they get paid,” he added.
If Philhealth’s financial woes worsen, he said the government might be forced to bail out the insurer at the expense of taxpayers.
“We are appealing to the Ombudsman and state auditors to intervene now before the problem worsens,” Aguilar said.
There were reports that some hospitals brazenly claim up to P30,000 for a simple cataract operation that normally costs only P7,000.
Philhealth collects P100 to P750 in monthly premiums with half of the amount paid for by the employer. In return, workers get health insurance coverage via a network of accredited hospitals and physicians.
Philhealth officials themselves earlier admitted that the state-run health insurer may have lost anywhere from P2 billion to P4 billion to false or overstated claims over the last 10 years. – Mayen Jaymalin, Philippine Star
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