P4B scammed by some doctors/hospitals from the Philhealth

[mazdamazda]

Tsk, tsk, tsk...

I hope that they can take their P4B to their graves.

P4-B Philhealth scam bared

By Veronica Uy
INQUIRER.net
Last updated 08:25pm (Mla time) 05/29/2007

MANILA, Philippines -- Some doctors and hospitals have defrauded the government’s Philippine Health Insurance Corp. (PhilHealth) by P4 billion in unnecessary or overpriced medical procedures since 1995, an official has disclosed to the Senate.

Dr. Madeleine Valera, PhilHealth vice president for health finance policy, said fraudulent claims included one doctor who conducted more than 2,000 cataract surgeries worth P17 million in one year. She said among the cases being investigated by PhilHealth were those involving circumcisions and toenail extractions.

“It would appear [from medical records submitted to PhilHealth] that a lot of Filipinos are supot [uncircumcised] and have infection on their toenails,” she told a hearing Tuesday.

“May mga raket din ang mga doctor [Doctors also have their rackets], more as individuals than as syndicates. Some doctors are in on the scam. Many have earned millions from PhilHealth,” Valera said.

She said the scam involved some “scalawag” doctors treating “ghost patients,” and making “dubious claims.” Others “harvest” these patients by enrolling them in PhilHealth before they are treated.

Valera said that in some cases, hospital-based pharmacies were also involved. She said doctors would prescribe medicines that were not needed by the patient but only to pad the hospital bills.

Senator Richard Gordon, head of the Senate committee on government corporations who called for the off-session hearing, said, “The national government is the biggest violator of premium payments,” with P5 billion in unpaid PhilHealth premiums.

The hearing was conducted following published media reports that some hospitals were going on “holidays” as a reaction to the passage of the law banning them from detaining patients who could not pay the entire hospital bill.

Melinda Mercado, PhilHealth senior vice president for operations, admitted that PhilHealth had been late in paying for the hospital bills of their members. She explained that this was because of a new PhilHealth system that would allow verification of premium payments before hospitals were actually paid.

“It is not for lack of money. [The delayed payment] is an operational problem. We have shifted from a localized system to an integrated system. We are still adjusting to this centralized computerized system where all data may be checked,” she said.

Mercado said the delayed payment was also caused by the mass migration of doctors, who acted as evaluators of medical cases. Medical cases are evaluated to determine actual medical needs.

“Doctors are leaving the country, many as nurses. And we have been finding it difficult to find replacements,” she said.

Gordon said the hearing exposed the weaknesses in the Philippine health system. “These overcharging and harvesting of patients are a sad commentary of the times. This problem needs to be addressed by the PRC [Professional Regulation Commission] and medical associations so that these malpractices are excised and exorcised,” he said.

[uls]

Kung ano ung major headache of a mess na nangyayari sa US healthcare system (medicare/medicaid), it's gonna happen to Philhealth. Same design e..

[oldblue]

pag na-confine ka bibisatihin ka lang once a day with a whooping Php 4-13k per night. tapos bobola-bolahin at tatanung-tanungin ka

i always believed doctors are just for emergency purposes. so always try to avoid them at all cost, like eating well. para hindi magkasakit now or in the next 20 years.

pero seems like they know this, kaya mayroon na din sila "ghost" patients.

[XTO]

Tsk, tsk, tsk...

I hope that they can take their P4B to their graves.

If this is true, then, it's only the Philhealth to blame. In the first place, this fraudulent claims have been going for for years now, piling up the losses to reach that big. Have they not instituted verification, auditing or other means of authenticating charges? This is a simple case of initiating administrative policies that can spell the salvation of this institution.

Lahat naman ng government agencies may mga scams. Ang tanong dito is bakit ngayon lang lumalabas mga ito?

[mazdamazda]

If this is true, then, it's only the Philhealth to blame. In the first place, this fraudulent claims have been going for for years now, piling up the losses to reach that big. Have they not instituted verification, auditing or other means of authenticating charges? This is a simple case of initiating administrative policies that can spell the salvation of this institution.

Lahat naman ng government agencies may mga scams. Ang tanong dito is bakit ngayon lang lumalabas mga ito?

Even din naman sa insurance ganito din ang kaso... may gumagawa ng mga fake claims. Remember the promo of some insurance agents who promise you a new paint job if you get insurance for them and sign a dubious claim for it?

Ang mahirap sa PhilHealth currently ay built ang system for easy claims and availment para sa mga pasyente. Laking hassle sa mga patients if may bagong mas mahigpit na scheme dahil sa kagagawan ng ilang doctor/ospital.

[mikeye]

Philhealth would benefit patients, doctors and hospitals. (but mostly patient)

patients - deductions from their total bill applies
doctors - deductions from their total fees applies (but will have to wait 3-6months before they get their money)
hospital - deductions from patients total room expenses and medicines that are chargeable to philheath.

Philheath Insurance released the indigent program which supposedly are for indigents.......sad to say some of these indigent members are not really poor....

In case, the illegal detention of patients push thru.......ano kaya ang magyayari sa health care system natin....

true - not all hospital and doctors are like the ones mentioned above.....

pero....pano naman yung medicines, services, electric bills, etc.....LIBRE na nga lang ba ito?....eh di magsara na mga hospital....walang pondo.

hospitals and doctors do give charity to patients......pero hindi naman pwede lahat charity.

just a thought.

[oldblue]

If this is true, then, it's only the Philhealth to blame. In the first place, this fraudulent claims have been going for for years now, piling up the losses to reach that big. Have they not instituted verification, auditing or other means of authenticating charges? This is a simple case of initiating administrative policies that can spell the salvation of this institution.

Lahat naman ng government agencies may mga scams. Ang tanong dito is bakit ngayon lang lumalabas mga ito?

kaya nga hindi ako naniniwala pulitiko lang dahilan ng downfall natin eh. right now even our well-respected professional community, gumagawa ng anomalya. and they're doing it "professionally"

[XTO]

Even din naman sa insurance ganito din ang kaso... may gumagawa ng mga fake claims. Remember the promo of some insurance agents who promise you a new paint job if you get insurance for them and sign a dubious claim for it?

Ang mahirap sa PhilHealth currently ay built ang system for easy claims and availment para sa mga pasyente. Laking hassle sa mga patients if may bagong mas mahigpit na scheme dahil sa kagagawan ng ilang doctor/ospital.

Yes, if what Philhealth officials are claiming is true, then, we the victims would be the Philhealth members themselves espcially those honest individuals who would like to claim health benefits. If the officials would make this state as an excuse and reason, then future claimants will have a hard time availing its benefits.

kaya nga hindi ako naniniwala pulitiko lang dahilan ng downfall natin eh. right now even our well-respected professional community, gumagawa ng anomalya. and they're doing it "professionally"

Yes, on top of our endemic corrupt political setup, we have this culture of cheating that has been perfected by our much vaunted Filipino ingenuity.

[surg]

pag na-confine ka bibisatihin ka lang once a day with a whooping Php 4-13k per night. tapos bobola-bolahin at tatanung-tanungin ka

i always believed doctors are just for emergency purposes. so always try to avoid them at all cost, like eating well. para hindi magkasakit now or in the next 20 years.

pero seems like they know this, kaya mayroon na din sila "ghost" patients.

i beg to disagree. doctors (non-surgical or those who don't do operations)usually based their professional fees on the room rate/day or even lower, ex: if your room costs 400 pesos/day then the professional fee is also 400 pesos/day and even lower if the patient had philhealth coverage so your claim of 4-13k/night is downright ridiculous and baseless! maybe what you're referring as 4-13k/night is a hotel rate esp a 5 star hotel. and even though if you're eating well, not getting sick for 20 years is an impossibility. doctors are also humans so there's also "bad eggs" like in any profession so don't generalize. its narrow minded and suspicious guys like you who usually don't get well ( because you tend to go "shopping" for several doctors) because trust and belief in your doctor is very important in treatment of any disease

[oldblue]

forgive me for being blunt sa mga doctors. pero talagang hirap ako i-appreciate sa mga profession na nag-thrive sa misfortune of others like sickness is to doctors and domestic dispute is to lawyers.

bali-baligtarin pa natin, andyan talaga yun puwede abusuhin at pagkaperahan dahil no choice na.

bakit ba na naimbento ang healthcare system? bec. of fear. na pag inabutan ka ng misfortune, tapos short ka, wala ka matakbuhan. ok lang naman kung ganito.

but it seems like our "enterprising" doctors found another way to exploit it to their advantage.

and yes uls, is right. ipapasa na naman sa philhealth members yan mga pilferage na yan.

4B is a lot of money.

[smooth]

forgive me for being blunt sa mga doctors. pero talagang hirap ako i-appreciate sa mga profession na nag-thrive sa misfortune of others like sickness is to doctors and domestic dispute is to lawyers.

first, i'd like to state that i am a doctor. secondly, you honestly believe that as a physician, i am thriving on the misfortune of others? whoa. what do you want us to do for a living? anyway, if you feel that you shouldn't compensate the doctor who helped you with whatever ails you, you are most welcome to try out the various charity hospitals in our country. wala kang babayaran na duktor doon. libre ang pagpapagamot. LIBRE.

no one is pushing you to pay for doctors' professional fees. no one is going to thrive off of your misfortune from sickness if you don't want them to. go to a charity hospital and your apprehensions will be solved.

what i find amazing are people who elect to go to a private hospital and yet do not want to pay for it. isn't that like going to a classy restaurant when you're darn hungry, ask for the most expensive steak, and then sincerely believe that you shouldn't pay for it?

i know. i know. i'm off topic. sorry. i'm just surprised by mr oldblue's comment.

[smooth]

pag na-confine ka bibisatihin ka lang once a day with a whooping Php 4-13k per night. tapos bobola-bolahin at tatanung-tanungin ka

i always believed doctors are just for emergency purposes. so always try to avoid them at all cost, like eating well. para hindi magkasakit now or in the next 20 years.

...and this one is the icing on the cake, so to speak. like i said, libre ang bolahan sa charity hospital. one-to-sawa. kung namamahalan ka sa 4-13K a night na bolahan, pumunta ka sa charity hospital. doon LIBRE ang bolahan. kung gusto mo, buong umaga hanggang gabi kayo magbolahan ng libre.

incidentally, saan ka na-confine na siningil ka ng pambobola ng 13K a night? matindi-tinding bolahan yun a. 13,000 a night? ilang gabi ka binola ng 13K a night? patok yung nambola sa iyo ah. nakahanap siya ng jackpot hehehe i suppose there's one born every minute hehehe

well, in the end, wala namang mabobola kung walang magpapabola (especially to the tune of 13K a night).

[Isuzoom]

tagal na ito...malaki talaga pera diyan di lang nakikita.

[oldblue]

pasensya ka na sir kung na-offend kita pero I'm just speaking from experience lang. I got hospitalized for so many times already kaya nilalabas ko lang dito reklamo ko sa mga doctor.

way way back, I got hospitalized for more than a week. my healthcare recommended a specialist. throughout the duration of the week, he visited me 3-4 days lang sa room, and usually nakikipag-bolahan lang. papatawanin ka, kumusta ka na, let's just wait and see, obserbahan muna kita etc..

my hospital bill reached almost a 100k, and this was year '97. sinagot naman ng healthcare lahat including his professional fees. 5 months later, tumawag secretary nya, sinisingil pa ako additional professional fees. sabi ko diba sinagot na naman ng healthcare, since healthcare mismo nag-recommend.

iba pa daw yun tsi-narge nila sa healthcare, kasi gumaling naman daw ako. papa-guilty pa. anyway, this also happened to a relative of mine and my mom in different cases and different doctors.

kaya nasabi ko grabe pala mga duktor, kahit may healthcare ka na, and tipong brief dalaw lang once a day. maniningil pa kung makakalusot kahit nabayaran na ng healthcare.

they will really insist on the professional rate, kasi siguro na-discounted sila ng healthcare. at ang pupuntiryahin eh patient.

[mikey177]

Anyway, back to the topic...

Some doctors and hospitals have defrauded the government’s Philippine Health Insurance Corp. (PhilHealth) by P4 billion in unnecessary or overpriced medical procedures since 1995, an official has disclosed to the Senate.

...The hearing was conducted following published media reports that some hospitals were going on “holidays” as a reaction to the passage of the law banning them from detaining patients who could not pay the entire hospital bill.

It appears that there is a multifaceted problem affecting the country's health care sector.

On one hand you have a health insurance system that is vulnerable to abuse, but which is also slow (it takes three or more months for claims to be paid) in responding to legitimate claims from health care providers.

On the other hand, you have this brilliant new law authored by Sen. Villar (which is why I didn't vote for him) that makes it illegal for hospitals to detain patients who cannot settle their bills, without regard to how this will affect the cash flow of the private hospital. These hospitals do need to make money in order to keep treating patients, and maybe only 1 out of every 10 patients that issues a promissory note actually comes back to pay it.

In addition, you have the continuing exodus of skilled health care professionals for foreign lands, resulting in a lack of qualified personnel to take care of patients. Professionals who are leaving are not limited to doctors and nurses, but even medical technicians, radiology technicians, occupational and physical therapists, and many others involved in health care. For many, it simply isn't worth the effort and aggravation to stay in the Philippines.

So, how are we, as ordinary citizens, going to help in solving this crisis?

[uls]

Lawmakers come up with POPULIST regulations coz being pro-poor makes them look really good.

---------------------------------

Hospitals are just like any business... cashflow is lifeblood.


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Hindi ba kaya nalugi ung Makati Med is coz of millions in unpaid bills?

[ogpro]

Anyway, back to the topic...



It appears that there is a multifaceted problem affecting the country's health care sector.

On one hand you have a health insurance system that is vulnerable to abuse, but which is also slow (it takes three or more months for claims to be paid) in responding to legitimate claims from health care providers.

On the other hand, you have this brilliant new law authored by Sen. Villar (which is why I didn't vote for him) that makes it illegal for hospitals to detain patients who cannot settle their bills, without regard to how this will affect the cash flow of the private hospital. These hospitals do need to make money in order to keep treating patients, and maybe only 1 out of every 10 patients that issues a promissory note actually comes back to pay it.

In addition, you have the continuing exodus of skilled health care professionals for foreign lands, resulting in a lack of qualified personnel to take care of patients. Professionals who are leaving are not limited to doctors and nurses, but even medical technicians, radiology technicians, occupational and physical therapists, and many others involved in health care. For many, it simply isn't worth the effort and aggravation to stay in the Philippines.

So, how are we, as ordinary citizens, going to help in solving this crisis?

I'd tell you to vote...but that obviously hasn't been working.

I say a revolution is in order hehe.

[uls]

Politicians keep on patronizing the poor, giving them free this and free that.

Guess at who's expense? Tayo. We, the paying public, are actually subsidizing the poor.

A part of our medical bills is actually covering the losses incurred by the hospitals.

[XTO]

Hospitals are just like any business... cashflow is lifeblood.



---------------------------------



Hindi ba kaya nalugi ung Makati Med is coz of millions in unpaid bills?

hospitals are indeed business enterprises that thrive or dive according to the health of their cash registers. this baloney about noble objective as "saving lives" comes only incidental to "saving pockets."

makati med bled because of meds' mismanagement, i believe that businesses like hospitals are better left to the administrative care of business professionals.

[uls]

Free healthcare is politically very popular but it doesnt make economic sense.

I mean everything related to healthcare costs a lot of money.

When govt starts to force healthcare related businesses to lose money, capital will move away from investing in those businesses.

If i were a doctor (ya right), i'd rather be a plastic surgeon. That way, i will only be dealing with customers with a lot of money.