Quezon City Eye Center decries fraud allegations

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The Quezon City Eye Center, a leading PhilHealth-accredited facility specializing in cataract surgery for the poor and senior citizens, has  decried insinuations that it was engaged in the filing of fraudulent claims in the cataract package of PhilHealth.

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Speaking for the popular 18-year-old facility, Lorna Kapunan, a lawyer, said, “It is good for PhilHealth and the Department of Health (DOH) to continuously monitor and audit its accredited institutions. The safeguarding of funds meant for the poor and senior citizens is a must.  To insinuate, however,  that the QC Eye Center is engaged in fraudulent acts is grossly unfair and prejudicial to the dedicated professionals who provide quality and successful cataract operations at the lowest possible cost.”

“The high number of patients treated successfully attests to the fact  that the QC Eye Center is favored by the poor and recently by senior citizens because it charges even lower than some government hospitals,” Kapunan added in a statement on Friday.

The QC Eye Center was established in 1997 and accredited by PhilHealth as a health care provider in 2002.

The center, according to the statement,  has provided high-quality services to approximately 35,000 mainly poor patients and has maintained a good track record of restoring vision to patients with cataracts in a good clinic environment similar to other institutions that charge exorbitant fees.

Its policy of affordable cataract surgery significantly pre-dates the “No Balance Billing” policy of PhilHealth.

Inclusion of all senior citizens in PhilHealth coverage has caused a “significant increase in cataract surgeries.”

Despite the unwarranted insinuations, Kapunan relayed the center’s position that it stands together with PhilHealth and the DOH in providing expanded quality medical services to the poor and disadvantaged.

During a news conference held by  president of PhilHealth and lawyer Alex Padilla and DOH Secretary Janette Garin last May 22, the QC Eye Center was mentioned as the subject of an ongoing audit on the utilization of the cataract package of PhilHealth.

It was “further insinuated that [the]center may be involved in the anomalous filing of fraudulent claims which undermines the objectives of PhilHealth and the DOH to provide affordable cataract surgery to the poor.”

Kapunan pointed out that”nothing could be farther from the truth.”

The QC Eye Center “prides itself in spearheading the move to deliver services to the poor and we will continue to do so to the best of our ability and resources.  We sincerely believe that we have created a system where the delivery of health care is most relevant to our society and we have tens of thousands of patients who can attest to this,” the statement said.

This policy of “pure Philhealth cataract surgery” has been adopted by several other facilities that resulted in tremendous increase in cataract surgeries in the country. Rather than an indication of fraud, the increase could be regarded as a successful implementation of sound policy by PhilHealth,” it added.

“Understandably, the pure PhilHealth policy of the QC Eye Center did not become popular with numerous doctors and institutions who would rather have the patient pay extra for added income.  The P16,000 that Philhealth provides for cataract surgery is way below what bigger hospitals or other eye centers charge that range from P60,000 to P120,000 per eye,” the statement said..

The center said it “welcome[s]the audit being performed by PhilHealth.”

It added that  PhilHealth and the DOH are also “welcome to check our charts and forms to see if patients undergoing treatment in our center really do require said treatment and we are certain they will find everything in order.”

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3 Comments

  1. primer pagunuran on

    It is best to have the hospital or clinic in question to be investigated as part of normal audit process.

  2. Recently, Philhealth has been reprimanding government hospitals for not being able to accommodate all the needs of the patients under their “No Balance Billing” Policy, meaning that most government hospital patients have out-of-pocket expenses for tests or medicines that are not available in said hospitals and have to be acquired elsewhere. Now you have these eye facilities wherein patients, especially senior citizens, can rely on their Philhealth benefits with no out-of-pocket expenses because everything is provided by the facility…and Philhealth publicly admonishes them and accuses them of fraudulent claims without proper investigation!! This simply means Philhealth has to get their act together….simply a case of the right hand not knowing what the left hand is doing…shame on Philhealth and shame on the DOH! Both agencies are acting against the Aquino administration’s promise to universal access to quality health care! SHAME ON YOU!!!