PhilHealth investigating around 15,000 cases involving healthcare institutions, doctors

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Metro Manila (CNN Philippines, July 9) — The country's health insurance provider is investigating thousands of allegedly anomalous benefit claims involving doctors and partner institutions.

Speaking to the media Tuesday, PhilHealth's Senior Vice President for legal sector Rodolfo del Rosario said these cases were filed between 2015-2019 and involve around 400 doctors and 400 healthcare institutions.

"The cases are administrative cases lodged before: misrepresentation, upcases, multiple filing of claims, breach of warranties, karamihan 400 institutions nafile-an, more than 400 doctor-members," he said.

Upcases refer to instances where a patient claims to have an ailment that is worse than what was diagnosed; for example, claiming to have pneumonia when the illness is just a simple cough.

PhilHealth's new President and CEO Ricardo Morales said the total amount involved in pending cases is around P300 million.

PhilHealth has 12 lawyers leading the investigations, which will be prioritized according to the oldest and most expensive cases.

The agency hopes to finish the investigation before the Universal Healthcare Law comes into effect.

Morales said PhilHealth processes around a million cases per month, a number which they expect to double once the Universal Healthcare Law is enacted.

Morales said President Rodrigo Duterte told him "sampolan mo" [give them the punishment they deserve] when it comes to dealing with PhilHealth cases.

However, he said they could not do that, as all cases must be investigated fairly.

'Plug the holes'

Morales said his first order of business is "to plug the holes" in PhilHealth, adding he would like to resolve the the issues plaguing the agency "as soon as possible," but could not give a timeline on when these can be fixed.

Morales, a retired member of the Armed Forces of the Philippines, said his experience in the military as well as an insurance professional would help in running PhilHealth.

"We want to be able to serve the most marginalized sectors of our country — not just economically, but also geographically," he said at the press conference.

CNN Philippines correspondent Carolyn Bonquin contributed to this report.