Symptoms declared as COVID-19 for higher claims? DOJ gives way to PhilHealth probe

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Metro Manila (CNN Philippines, April 14) — The Department of Justice is letting the state health insurer handle the investigation into recent reports of medical care providers allegedly colluding with patients to declare minor respiratory symptoms as COVID-19 so they can get higher benefits.

Justice Secretary Menardo Guevarra said in a statement on Wednesday that while the DOJ-led task force investigated similar “upcasing” schemes and filed charges last year, it is giving way to the probe launched by the Philippine Health Insurance Corporation or PhilHealth.

“With a former NBI chief as President/CEO, PhilHealth can very well handle this new investigation,” Guevarra said. “But the DOJ/NBI (National Bureau of Investigation) will be ready to provide assistance if requested.”

PhilHealth President and Chief Executive Officer Dante Gierran replaced Ricardo Morales in August 2020, taking over an agency that was being investigated for corruption and other irregularities.

Over the past weeks, there have been social media reports that doctors would tell patients or family members that they would put COVID-19 as diagnosis, resulting in higher hospital bills, saying everything would be covered by PhilHealth. Patients who suffered asthma or heart attack are allegedly declared COVID-19 cases on paper despite not having the coronavirus.

PhilHealth on Monday urged those who posted the videos and others who have witnessed similar incidents to cooperate with its investigation, assuring them of protection.

It noted that “upcasing,” or wrongfully declaring more severe diseases or more complex procedures for higher PhilHealth claims, is a form of health insurance fraud. It is punishable with up to six years in jail, along with a fine of ₱200,000 and/or suspension of the health care provider’s contract for up to three years, PhilHealth noted.

The agency also warned that those who posted allegations of “upcasing” without any proof to back their claims can be held liable for cyber libel and violation of the Revised Penal Code for publishing “false information that may endanger the public order or cause damage to the interest of credit of the State.”