The Philippine Health Insurance Corporation has warned the public against unscrupulous individuals doing the rounds of hospitals victimizing patients who have no PhilHealth coverage.
The warning was issued after the arrest of a man who was identified by several patients at a hospital in Manila having posed as a PhilHealth agent offering to help patients avail themselves of PhilHealth benefits for a fee.
Lorna Fajardo, acting PhilHealth president and chief executive officer, said that these unscrupulous individuals would approach patients who do not have PhilHealth coverage and offer to have their memberships activated.
These “agents” would reportedly collect fees of up to P1,800 per patient and “remit” part of the premium to PhilHealth using fake contribution payment forms. The unsuspecting patients attach these fake forms to claim documents that they submit to the hospital thereby entitling them to PhilHealth benefits.
Upon processing of the claims however, PhilHealth discovered that the premium payment forms used were bogus and that the patients actually did not have the qualifying contributions that will entitle them to hospitalization benefits.
“This irregularity has prompted us to deny the claims altogether, to the detriment of our partner hospitals,” Fajardo said.
PhilHealth is set to file formal complaints against the suspect for falsification of public documents and for misrepresentation resulting to financial losses.
“We call on the public to be more vigilant and to watch out for people who try to defraud the National Health Insurance Program thru various schemes. We urge everyone to report similar incidents to our Fact Finding and Administrative Investigation Department at telephones 637-6460 or 638-3086 so that we can act on them promptly. Also, transact only with our authorized personnel or better yet, visit any of our offices nationwide for all your PhilHealth concerns,” Fajardo said.
She also called on accredited hospitals in the country to closely examine the documents being submitted by member-patients to ensure that only those who are qualified to avail may enjoy hospitalization benefits. — Jasmin R. Uy/MEEV