Philhealth to probe reports of ‘upcasing’ of minor respiratory ailments to Covid-19

THE state-run Philippine Health Insurance Corporation (Philhealth) on Monday said it will probe allegations of “upcasing” following the proliferation of video posts that health-care providers allegedly collude with patients to declare minor respiratory symptoms such as asthma as Covid-19 to claim higher benefits.

The state health insurer also urged on Monday those who posted the videos to provide the necessary proof and fully cooperate with the probe.

As a form of health-insurance fraud, upcasing refers to claiming for a related illness or procedure of higher severity or complexity to gain higher benefit payment. It is punishable with a fine of P200,000 for each count, or suspension of contract up to three years of the health-care provider, or both. It also constitutes a criminal violation punishable by imprisonment for six months and one day up to six years upon the discretion of the court in accordance to Section 38 of the Universal Health Care Law.

“Philhealth reminded the public that protecting the Philhealth fund is also a responsibility of every member. It appealed to everyone who is in possession of credible information on such unethical acts to report directly to Philhealth together with evidence so that the agency can act swiftly,” Philhealth said in a news statement.

However, it also reiterated that the National Health Insurance Fund is considered a public fund and that any form of abuse should be dealt with in accordance with the law.

At the same time, it also warned against posted information without any proof to support their claims, especially at this time of the Covid-19 pandemic.

“They instead malign and compromise the reputation of hospitals, doctors and even the agency itself, acts that may lead to legal actions such as cyber libel and violation of Article 154 of the Penal Code criminalizing publication of false information that may endanger the public order or cause damage to the interest or credit of the State,” it said.

Whistle-blowers and concerned citizens are encouraged to report cases of upcasing or any form of health insurance abuse through:

Face-to-face meetings (observing minimum health protocols); nearest Philhealth offices e-mail:whistleblower@philhealth.gov.ph; actioncenter@philhealth.gov.ph;opceo@philhealth.gov.ph

Mail: Room 1711, 17th Floor Citystate Centre, 709 Shaw Boulevard, Pasig City

Telephone: (02) 8441-7442

Philhealth also assured the public of utmost confidentiality of reports, as well as protection and possible assistance to the whistleblower as provided for by law.

Last year, corruption allegations hounded the state health insurer. Its former anti-fraud legal officer Thorrsson Montes Keith claimed that some corrupt officials from the agency pocketed P15 billion.

But Philhealth last month said 98 percent of this amount released under Interim Reimbursement Mechanism had already been properly accounted for.