PhilHealth told: Okay eye surgeries for now

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Recent scams uncovered by the Philippine Health Insurance Corp. (PhilHealth) should not stop the agency from approving claims for cataract surgeries.

Meanwhile, Sen. Francis Escudero on Sunday said, PhilHealth should come up with effective ways in validating claims.

Escudero made the statement after learning that PhilHealth has temporarily suspended payment of claims for cataract surgeries filed by Pacific Eye Institute in Makati City and Quezon City Eye Center, both in Metro Manila, in wake of the discovery of the anomaly in claims it had filed.

He said cataract removal was the 5th most common procedure reimbursed by PhilHealth in 2014, accounting for 128,331 surgeries that cost P2,056,379,782.


“I hope the incident will not result in the total stop of cataract operations offered by PhilHealth to its members,” Escudero added.

He said PhilHealth just needs to be thorough about validating claims.

The senator disclosed that the Senate will look into safeguard mechanisms in place at PhilHealth to ensure that government allocation for health coverage of the poor would not go to scammers.

Escudero said they would look into the check-and-balance and safeguard mechanisms of PhilHealth in order to protect government funds intended for health care.

He added that while health insurance fraud is also happening in the United States and other countries, PhilHealth must come up with means to prevent syndicates from abusing the country’s health care system

The government, in 2014, earmarked P35 billion for PhilHealth premiums to cover 15 million indigents in the Philippines.

That allocation represented a 179-percent increase in government health subsidy for the poor.

In the same year, PhilHealth made a total of P78 billion in benefit payments, 23 percent of which went to private hospitals and clinics.

For 2015, over P36 billion has been set aside for premium payments of indigents.

In the continuation of the Senate blue ribbon committee on the reported PhilHealth claims fraud, the Department of Health revealed that some local government units (LGUs) are in cahoots with private clinics in subjecting PhilHealth members to unnecessary surgeries that will be charged to the government health care provider.

Some LGUs are using government resources and even employees to recruit patients in barangay (villages) and bring them to a private hospital or ambulatory surgical center that are owned by relatives or business partners of a local government official.

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