DOH probes PhilHealth disbursements

MANILA, Philippines - Is it possible for a doctor to perform 1,555 cataract surgeries in one year?

This is the question that the Department of Health (DOH) is trying to answer as it investigates how the Philippine Health Insurance Corp. (Philhealth) reimbursed an ophthalmologist for that number of operations in 2009.

Health Secretary Enrique Ona said his department wants to know if the operations really took place, since these cost the Philhealth some P28 million in 2009.

“I’m not saying that it was all a racket. Maybe the unmet needs of our people, especially among our senior citizens, for cataract operations are really that much. But that has to be proven,” he said in a press briefing during the 15th anniversary of the University of the Philippines-National Institute of Health.

Ona noted that since a fixed reimbursement rate of P18,000 was set for each eye operated on for cataract two years ago, “it became the highest paid service of Philhealth.”

“The four top (reimbursements were paid) to ophthalmologists. As a matter of fact, the top one had a very little practice two to three years ago... But with the advent of Philihealth, (that doctor) became that number one paid by Philhealth,” he added.

Health Undersecretary Ted Herbosa said it seemed statistically improbable for a doctor to perform such a number of operations in a year’s time.

“When we computed, it was like you have to do 30 cataract operations a day to reach such reimbursement rate. P18,000 per eye so technically, you could get P36,000 from one person for two eyes,” he said.

Herbosa added the other concern of the DOH is the possibility that there are cataract patients who did not really need to undergo surgery but were operated on so that their ophthalmologists could collect from Philhealth.

“Maybe they were doing surgeries even if the patients only needed eye glasses just to be able to reimburse from Philhealth,” he said.