Philhealth board sets up anti-fraud task force

THE Board of Directors of the Philippine Health Insurance Corporation (Philhealth) recently established a high level Anti-Fraud Task Force that will spearhead moves to prevent the occurrence and recurrence of activities that defraud the National Health Insurance Program (NHIP).

The Task Force will review, improve or create processes, systems and policies to prevent fraudulent activities from recurring. It will also assess the composition and current functions of the Fact-Finding Investigation and Enforcement Department (FFIED), and identify areas prone to fraudulent activities, considered red flags.

The Task Force is comprised of Board Members, headed by Health Care Provider Sector Representative Dr. Joan Lareza, and PhilHealth Senior Vice Presidents. Other members are the Board Members heading the Risk Committee, Audit Committee, and Committee on Appealed Administrative Cases, namely, Dr. Anthony Leachon, Chairperson of the Government Service Insurance System Dr. Francisco Duque and his alternate Atty. Lucio Yu, and Dr. Hildegardes Dineros. Board Members Dr. Roy Ferrer, representing the Employer Sector, and Dr. Roberto Salvador representing the Formal Economy Sector, are also members of the Task Force.

Lawyer Germain Lim, Officer-in-charge of the Office of the Senior Vice President for Legal Sector, sits as Vice Chairperson of the Task Force. The Senior Vice Presidents for Health Finance Policy Sector, Actuarial Services and Risk Management Services, as well as the Vice President for Member Management Group and the Head of the Task Force Informatics are members. The FFIED acts as the Secretariat and subject matter expert.

The PhilHealth Management has been tasked to follow through on all anti-fraud related directives, specifically directing all Regional Offices to report all fraud-related activities in the region. Philhealth/ PIA