Philhealth and NBI join forces to combat health insurance fraud

THE Philippine Health Insurance Corporation (Philhealth) recently forged an agreement with the country’s leading investigating authority National Bureau of Investigation to go after illicit activities that are potentially defrauding the National Health Insurance Program.

The parties have agreed on a shared set of responsibilities to detect, deter, and prosecute fraud committed by health care facilities and professionals, and even those made in collusion with its own officers and employees.

Under the agreement, Philhealth may request for investigative assistance from the NBI including surveillance, investigation, and entrapment of violators, if needed. Further, Philhealth officers and employees may be called on as witnesses for complaints to be filed by the Bureau arising from the investigations. All pertinent records, documents, and information must be turned over by Philhealth to the NBI to help resolve the cases.

Quoting the Holy Scripture, Gierran said that “Two are better than one, because they have a good return for their labor. If either of them falls down, one can help the other up.” He also said that collaborative efforts of Philhealth and the NBI would result in a definitive action against fraud that was taken up in Congressional inquiries last year.

For his part, Distor said that the MOA, “…essentially outlines how the Bureau and Philhealth will work together as a team in combating graft and corruption and in gaining back the trust and confidence of the people in government-subsidized health care system.”

He vowed that the NBI shall “…respond swiftly and appropriately to a complaint, relevant tip-off, information, and/or lead provided by Philhealth whether referred by Philhealth head office or regional office including its legal offices, to determine possible violations.”