By Nancy Carvajal
The Philippine Health Insurance Corporation (PhilHealth) has no plans of going after hospitals who received payments for fraudulent claims despite the multibillion-peso losses incurred by the state health insurer due to overpayments.
A Philhealth official revealed the agency’s lack of policy for recovery of losses during a meeting with the task force investigating the state health insurer, Politiko learned.
“It is evident that there is inadequate top management effort to recover government losses due to fraud and overpayment,” a source said.
Philhealth fraud detection mechanism Machine learning Integrated Data Analytics System (MIDAS), has recorded suspected claims of “upcasing’’ cases amounting to billions of pesos nationwide.
However, Politiko’s source said the data needed for PhilHealth to take action is missing.
Apart from missing data, Philhealth has also deficient management strategy to address fraud thus prevent losses.