Scam pa more! Philhealth's loss totalled P154 billion

Photo from Rappler

In a report by Inquirer, officials detailed how Philhealth lost a humungous amount of money. Said officials requested their identity to be kept confidential for their safety.

According to them, the existing all-case rates, also called ACR, payment mechanism was one of the reasons why Philhealth lost a total of P154 billion since 2013.


From the losses over the past six years, P102.5 billion was due to overpayment.

The sourced persons arrived with the amount using the data from the Commission on Audit (COA): 2014 audit observation memorandum for Northern Mindanao. The audit found that PhilHealth had overpaid in 20 percent of all cases it processed.

Meanwhile, the officials revealed that the other P51.2 billion was lost to fraud. It was based on the global estimate of a 10-percent loss as a result of health care insurance scams.

The health insurance company's benefit payout totaled P568 billion between 2013 and 2018.

Since Philhealth abandoned a fee-for-service scheme, the agency has been paying hospitals a set rate for a particular disease

For example, patients diagnosed with community-acquired pneumonia are covered for P15,000 each, but for those who contracted the more severe strain, they are alloted with P32,000. Pneumonia has consistently ranked as the most prevalent disease reported by hospitals since 2010.

President Duterte noted that he does "not have the slightest doubt about the integrity and honesty" of Philhealth chief Roy Ferrer, however, he also noted that losses of some P100 billion is "totally, totally unacceptable."


"As of last count, it (losses) was about 154 something, if I’m not mistaken, billion," the Chief Executive claimed.

For him, it needs a "military man" or "business people" whose expertise are "purely management" to get rid of the system plagued with fraud.

"The sheer number of people to be supervised is just so daunting. And that is why you need to a systems analyst to make it easy for you, especially to establish the checks and balances somewhere there," the President said.

"Sana when it becomes clear that the amount is getting big, somebody should look somewhere," he said.

To look into possible liabilities of government officials, Pres. Duterte already ordered the arrest of WellMed owners, the firm involved.

The agency announced that it would hire 130 fraud investigators, 12 more lawyers, and 54 doctors to help with the validation of the alleged fraudulent claims.

On Saturday, President Rodrigo Duterte said he would "reorganize" the Philippine Health Insurance Corporation (PhilHealth).

"For the sheer amount that was lost, I have to reorganize your entity, change maybe all of you and install a more --- systems of accounting and accountability," he said.


Sources: Inquirer, ABS-CBN

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