PhilHealth cataract scam medical missions uncovered.
By Christian V. EsguerraInquirer Last updated 07:47pm (Mla time) 09/23/2007
MANILA, Philippines--There was something amiss about one medical mission in Iloilo.
Barangay (village) officials purportedly representing a private hospital were offering residents of far-flung areas free trips to the hospital in another province for cataract operations. All they needed, they were told, were their Philippine Health Insurance Corp. cards.
For those not enrolled in the government health insurance program, the representatives—known in insurance circles as “seekers”—offered to shoulder the quarterly premium of P300.
Not only that, their meals during the trip and operation would be taken care of.
“It was too good to be true,” said Iloilo Rep. Janette Garin during the subcommittee hearing on the proposed P16.2-billion budget of the Department of Health for 2008.
So what was the catch?
Garin, a medical doctor, said some private companies—through “seekers”—were enjoying hefty returns on their “investment” by submitting enormous claims to Philhealth, a government-owned corporation.
Based on documents she obtained from Philhealth, Garin cited the case of one Bacolod hospital that purportedly overcharged Philhealth by more than 200 percent for a simple cataract procedure.
Garin said the hospital made claims of around P30,000 for each eye operation. In an interview with the Philippine Daily Inquirer after the hearing last Thursday, Garin said a cataract operation cost only around P7,000.
She said the racket could be happening in other parts of the country as well.
With an estimated 2,000 cataract operations performed annually, the hospital could be raking in as much as P60 million, according to the lawmaker.
Garin said the amount could easily shoot up since the same hospital opened two facilities in Iloilo and Mindanao .
“We're only talking about cataract operations,” she told the health officials present led by Health Secretary Francisco Duque III. “What more for other illnesses?”
Garin said the practice of jacking up Philhealth claims would eventually bleed the insurance program dry.
Quoting from the Philhealth documents, she said four doctors alone put in claims totaling P5 million in six months. She noted that regular claims submitted for the same period were usually only for between P150,000 and P300,000.
Duque confirmed the practice of some hospitals and medical missions using “seekers.”
“They [doctors] cast their net on indigents and pay for their premiums and operate on them,” he said.
Duque said the government tried to correct the situation by implementing the “regularity of contribution” rule where a Philheath member could undergo surgery only after nine months from the initial premium payment.
“I know it’s a difficult and ambitious statement to say that we will completely get rid of all these shenanigans,” he said. “[But] we assure the congresspersons that Philhealth has been working to curb, if not, eliminate [the practice].”
Garin said the issue also involved the safety of medical procedures done in hospitals involved in the racket.She said about 10 cases of patients going blind were reported in her province as a result of the medical missions. She said there were also cases where “seekers” brought in—not cataract patients—but those who had glaucoma.