PhilHealth to investigate complaints of ‘upcasing’

STATE insurer Philippine Health Insurance Corp. (PhilHealth) said it has started investigation on numerous cases of “upcasing” — the act of reporting a mild illness as something severe like pneumonia or Covid-19 to increase BENEfiT CLAIMS.

PhilHealth said it received more than 900 complaints of upcasing since the start of this year and around 2,000 last year.

“Most of the cases were detected during claims processing or when our anti-fraud team was checking records to be forwarded to hospitals,” PhilHealth Vice President for Corporate Affairs Dr. Shirley Domingo said during the Laging Handa briefing on Friday.

Domingo said they are also investigating “ghost claims,” where people fake hospital confinement.

She urged patients to report any statement of account irregularity to PhilHealth’s Customer Assistance, Relations and Empowerment Staff or Cares representative in the hospital where they were confined or bring their complaints to the nearest PhilHealth office.

“Our current administration led by lawyer Dante Gierran is doing everything to prevent these kinds of fraud. He created an anti-fraud committee to expedite the resolution of cases,” Domingo said.

Domingo added that 98 percent of PhilHealth’s P15-billion Interim Reimbursement Mechanism (IRM) has already been liquidated by health care facilities.

The IRM was established to aid hospitals sustain operations during the Covid-19 pandemic.

The indemnity package for adverse Covid-19 vaccine reactions mandated by Republic Act 11525 has also been approved by the PhilHealth board in principle, awaiting the release of its P500million trust fund this month.