ILOILO CITY -- The House of Representatives is set to conduct an investigation on alleged fraudulent and irregular claims filed before the Philippine Health Insurance Corp.

Iloilo Rep. Janette Garin authored a resolution last week directing the appropriate committees of the House to conduct an inquiry on alleged irregularities in PhilHealth claims involving hundreds of millions of pesos.

The resolution, co-authored by Representatives Ma. Rachel Arenas (Pangasinan), Paul Daza (Northern Samar) and Roilo Golez (Parañaque) was supported by 40 other lawmakers, Garin said. The resolution pointed out that while on February 2005, an investigating team from the PhilHealth Western Visayas office already validated cases of alleged padding of claims and irregularities in the recruitment of patients for cataract operations charged to PhilHealth, the government insurance corporation has taken "no concrete steps to initiate reforms."

"(The) reports should not be taken lightly and the extent of such illegal activities should be ascertained given the magnitude of the resources that are allegedly being lost through fraudulent claims,_according to the resolution.

Amid continued reports of alleged irregularities in claims, PhilHealth last week issued a circular ordering a stop to payment of claims for cataract surgery during medical missions and through recruitment schemes.

The claims for cataract operations are the focus of PhilHealth investigations after patients and ophthalmologists complained of alleged padding in claims charged to the government insurance corporation and in the selection and recruitment of patients.

PhilHealth paid around P390 million to hospitals and doctors in Western Visayas for cataract operations from January 2004 to June 2007, according to data from PhilHealth's Corporate Planning Department.

In 2006 alone, PhilHealth paid P48,491,030 in professional fees to 10 doctors in Western Visayas for eye-related operations.

One ophthalmologist received P15,778,650 for 2,071 claims while the next highest paid got P14,226,450 for 1,825 claims. These equal a monthly average ranging from P1.1 to P1.3 million in earnings.

The House inquiry will also look into reports that the alleged fraudulent claims are also being done in other cases like circumcision and are being replicated in other hospitals.

"The alleged false claims can drastically affect the corporation's capacity to pay for the legitimate benefit claims and may threaten the long-term sustainability of the national health insurance program," read the resolution.

It said there is a need to inquire on the status of PhilHealth's efforts to investigate and prosecute those involved in defrauding the national health insurance funds through illegal claims.

The resolution said aside from investigating the extent of illegal activities that defraud PhilHealth, hospitals and doctors who have been found to be liable should be prosecuted and punished.

Lawyer Jay Villegas, manager of the PhilHealth's Fact-Finding and Administrative Investigation Department, said they found 10 possible padded claims when they sampled 50 patients randomly selected from patients of 10 doctors in Western Visayas who have performed cataract operations.

Garin said in a telephone interview that the National Bureau of Investigation will also conduct its own investigation on the alleged irregularities.*NPB

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