News

Isang Pagkilala at Pasasalamat sa Ama ng Generic Medicine

Posted on February 17, 2012. Filed under: News |

(From L-R) Ms. Olive Parilla of Homenet/ PATAMABA, Dr. Alfredo R.A. Bengzon, RiteMed Ambassadress Ms. Susan Roces and AGAP Lead Convenor Ka Bobby Tanada


Ayos na Gamot sa Abot-Kayang Presyo (AGAP), in a gathering of health advocates held on February 16, 2012 at Sulo Hotel, recognized the invaluable contribution of Dr. Alfredo R.A. Bengzon in the betterment of the Philippine Health Care System through the enactment of the Generics Law in 1988 and the creation of the Philippine Drug Policy during his stint as the then Secretary of Health.

The event also served as a celebration for the gains of Access to Medicines and the continued call to make it better.

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AGAP is now on Twitter!

Posted on January 24, 2012. Filed under: News |

Follow us for updates and more at @ayosnagamot or go to this link: https://twitter.com/#!/ayosnagamot

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How to cure Philhealth’s woes? | Newsbreak | Independent Journalism

Posted on June 15, 2011. Filed under: News |

How to cure Philhealth’s woes? | Newsbreak | Independent Journalism.

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AGAP calls for the immediate passage of HB 2174 (Amendments to the PhilHealth Law)

Posted on May 30, 2011. Filed under: News |

AGAP calls for the immediate passage of House Bill 2174 (Amendments to the PhilHealth Charter) filed by Cong. Erin Tañada and Congw. Daisy Fuentes.

The bill seeks to penalize fraudulent mechanisms in the system to avoid leakage of funds which could have been utilized to cover more indigent families in the National Health Insurance Program, among others.

The bill hopefully will resolve the issue of fraud as illustrated in the news item below.

NEWS DESK

Bogus claims haunt Philhealth
Published in http://www.newsbreak.ph
On May 25, 2011
By: Edwin Espejo
Maggie De Pano Fellow

MANILA, Philippines—For many years you’ve been paying your Philhealth dues, and so has your company. But that money may have been misused to finance bankrupt hospitals and fatten doctors’ salaries.

As early as four years ago, a scandal hit the Philippine Health Insurance Corp., which confirmed allegations that some private hospitals and doctors have been defrauding the state-run health insurer.

In her testimony before a 2007 congressional hearing, Dr. Madeleine Valera, Philhealth vice president for health finance policy, said that since 1995, Philhealth had lost as much as P4 billion due to fraudulent claims.

The anecdotes behind these claims are both tragic and true. In Iloilo, one eye doctor claimed to have performed 2, 071 eye surgeries in one year, for a total of P16 million in professional fees that he collected from Philhealth in 2006. When a Philhealth inspection team visited a hospital in Davao City, it caught janitors in hospital beds pretending to be Philhealth-accredited patients.

Today, various estimates show that Philhealth is still losing up to P500 million annually due to bogus claims. This amount can already cover additional 500,000 indigent families under a sponsored program scheme.

The continued abuse of the funds is also behind the limited coverage for new entrants to the labor force, since a new employee will have to contribute for at least nine months within the year of confinement before he or she could be entitled to benefits.

The problem persists because of government’s failure to prosecute any of the players involved in the scam.

While some hospitals, such as the Our Lady of Mercy Specialty Hospital in Bacolod and the General Santos Doctors Hospital in General Santos City, had been fined or suspended, the truth is no one has been jailed for the crime. Weighed down by manpower problems and lack of political will, Philhealth could only implement stop-gap measures to stop the bleeding, such as random inspections and a stricter evaluation of claims.

This special report focuses on the health insurance anomalies in Central Mindanao, covering the provinces of North and South Cotabato, Sarangani and Sultan Kudarat, and some areas in Mindanao.

Hospitals’ role

With its billions in funds, now at P69.5 billion, Philhealth is seen as a source of income for many provincial hospitals. In the General Santos Doctors Hospital, at least 20 percent of its estimated P120-million annual budget is derived from Philhealth reimbursements.

The percentage of Philhealth-sourced revenue is higher in accredited private hospitals, since the latter usually don’t set aside a budget for salaries and allowances of its resident doctors. And on the average, doctors claim about one-third of the total hospital bills of Philhealth-accredited patients.

What further motivates unscrupulous hospitals and doctors in padding their bills is the so-called “cost of money,” or the delay in Philhealth reimbursements, which take about 60 days to process.

In 2010, Philhealth released a total of P27.6 billion in benefit payments for a health insurance service that has 22.4 million members. That same year, it collected P26.4 billion in premium contributions.

The billions that Philhealth issued as benefit claims could not all be traced legally. In Central Mindanao, for example, the agency discovered that cheats had employed all tricks in the trade to access the Philhealth fund.

Ramon Aristoza, Philhealth vice president for Central Mindanao, cites an instance when they monitored a drastic rise in hospital confinement in the region. He soon found out that some hospitals were encouraging Philhealth members to confine their dependents in the hospitals as well. There was also a time when hospital confinements during weekends rose. Philhealth eventually learned that doctors had asked their patients to have executive check-ups and get confined during weekends, claiming higher benefits in the process. “As a matter of policy, we do not allow executive check-ups,” Aristoza tells Newsbreak.

Eye surgeries

Philhealth was given the opportunity to address this problem in 2007, when it discovered a scheme that defrauded the agency of a lot of money. Between January 2004 to June 2007, or in a span of 42 months, Philhealth paid 19,145 cataract-related claims in Western Visayas hospitals alone. The claims totaled over P390 million.

The numbers meant that these hospitals performed an eye-popping 15 eye surgeries daily for about four years—non-stop.

In one year alone, 10 doctors from Western Visayas were reported to have made claims amounting to P48,491,030 for eye-related operations.

One of these doctors from Iloilo performed a record-breaking 2,071 operations in one year, and claimed almost P16 million in professional fees in 2006.

“Many have earned millions of pesos from Philhealth,” Dr. Madeleine Valera, Philhealth vice president for health finance policy, told a 2007 congressional probe.

Western Visayas was just the tip of the iceberg. In Mindanao, provincial hospitals ransacked the Philhealth fund through the same scheme.

Philhealth sent a legal team from its central office to conduct a similar investigation on the General Santos Doctors Hospital (GSDH) in General Santos City, after it discovered an unusually high number of cataract operations performed by a single doctor.

Aristoza says cataract operations, along with circumcision and toe nail operations, were among the common medical operation used in making fraudulent claims. He explains that eye surgeries and circumcision are quick and easy, and can be done en masse, especially during provincial medical missions and outreach programs.

These medical missions are however free, but doctors were charging professional fees against Philhealth. The agency has since banned the practice.

Former congressman and now South Cotabato Gov. Arthur Pinggoy, confirmed that some doctors have taken advantage of medical missions to claim professional fees from Philhealth Pinggoy and former congressman Rey Aquino, a medical doctor who is now CEO of Philhealth, led the probe on bogus claims in 2007. Pinggoy chaired the committee on health; his family also owns a hospital in South Cotabato.

In Central Mindanao, one of its 10 accredited eye doctors stood out for the unusual number of claims he filed before Philhealth and those field on his behalf by one hospital. Eye surgeries in the region dramatically rose when Dr. Isaac Villegas was accredited by the General Santos District Hospital but also dramatically dropped when Philhealth started its probe.

Different tricks

Other hospitals and doctors were less refined in their schemes to defraud Philhealth.

Aristoza says the usual ploy is to overlap or pad claims—exorbitant professional fees, overpriced medicines and sometimes unnecessary prescriptions.

Some hospitals use ghost patients while others recruit Philhealth card-carrying members to fill up claims for non-existent confinement or medication. Willing Philhealth members are then given a fee for their participation.

In Davao City, a Philhealth inspection team caught a hospital with fake patients—janitors who were forced to lie in hospital beds upon the arrival of the team. The inspectors found out since they saw the janitors in bed still wearing their shoes, according to a member of the team who spoke on condition of anonymity since he was not a member of the team tells Newsbreak.

Others employ identity theft, where non-enrolled patients use the cards of legitimate Philhealth members. Lawyer Jusen Lubaton, Philhealth Region 12 chief legal officer, says that in the town of Isulan in Sultan Kudarat, a patient was able to obtain a birth certificate from the provincial registrar’s office even if he was using the identity of another person who is a card member.

Initial findings showed the involvement of local government units and officials, who sometimes own and run the hospitals.

Lubaton cites the case of Datu Saudi town in Maguindanao a few years back, where they got a tip that several health workers were “recruiting,” with the help of local officials, bogus patients for cataract operations. At that time, Maguindanao was still under the jurisdiction of Philhealth’s Central Mindanao region.

But Aristoza says they could not bring these officials to court due to lack of witnesses, not to mention the security concerns of Philhealth investigators. “You know how it is in Mindanao, Aristoza says as he acknowledges fears for their own safety.

Worse, even some Philhealth officials seem to be complicit. Aristoza admits they have received reports that some Philhealth employees may have participated in and even abetted the commission of fraud by providing health care providers and medical practitioners with ideas on how to file fraudulent claims.

But no one has come forward to press charges against these Philhealth employees. Those who were under cloud of doubt had already resigned, Aristoza says. “We just cannot make any accusations without any evidence.” (Next: The case that got away)

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PNoy prioritizes quality health care for the poor

Posted on February 18, 2011. Filed under: News |

AGAP is thankful that President Aquino prioritizes health care in his administration’s agenda based on statement issued and posted at president.gov.ph. (see statement below)

In this connection, AGAP pushes for the passage of HB 2174 filed by Cong. Erin Tanada and Congw. Daisy Avance-Fuentes which calls for the universal coverage of ALL Filipinos to the program. The bill seeks the enrollment of the ‘real’ indigent members of the society through the use of the National Household Targetting System (NHTS) of the DSWD and to capture the informal sector in the National Health Insurance Program (NHIP), among others.

News Desk

Aquino prioritizes quality health care for the poor
2011-02-14

President Benigno S. Aquino III on Monday said one of his administration’s top priorities in creating an equitable society is for every Filipino, especially the indigents and marginalized sectors, to be able to access quality health care.

“Closing the health gap among our people is a matter of top priority, especially if we are to succeed in building a genuinely free, fair and equitable society. We want our countrymen, particularly the poor, to be able to access medical care services, whenever and wherever they need it,” the President stressed in his message at the inauguration of the upgraded facilities of the East Avenue Medical Center (EAMC) in Quezon City.

Among the measures his administration is putting in place so the poor can access quality healthcare is the expansion of the coverage of the National Health Insurance Program to about 4.6 million indigent Filipino families in three years or less.

The Chief Executive added that he is also giving priority to the improvement of government health facilities and hospitals, where the poor can access sufficient medical care.

The Department of Health’s 2011 budget increase of 13.6 percent, according to the President, will be allocated to government hospitals, rural health units, and health centers for acquisition of functional equipment and competent health workers.

Moreover, the President said reforming the PhilHealth system is on going so as to increase the percentage of medical fees that will be shouldered by PhilHealth but in a way that does not compromise its financial viability.

He added that reforming the PhilHealth will not only save thousands of families from disease and illness, but will also keep them afloat during times of economic difficulties.

“At the bottom line, we are in the business of saving lives,” the President said.

People empowerment, he said, means allowing the people to lead healthy and productive lives which means requiring hospitals to meet their medical demands.

“You are our partners in nation-building. In order to protect the community from the threat of disease and illness, our doctors, nurses and staff must be imbued with the skills to ensure the welfare of the patients they serve.
It means making sure that, as our medical professionals are among the most committed in the world, so should our medical institutions be,” the President stressed.

He congratulated the EAMC for its significant feats and continuous efforts to deliver quality health care—from the upgraded facilities such as the Radiology Department, Birthing Center, Central Sterilization Unit, and the Tahan-Tahanan.

“It is my fervent hope that you will continue to help us as we fulfill our pledge to ease the burden caused by poverty. As we make certain that darkness does not eclipse this newfound daylight again, may we all stay on the straight and righteous path toward progress. Let us continue to stand under the banner of solidarity, and make sure that the Filipinos get the best medical service, and the quality of life they rightfully deserve,” the President ended.

posted at http://www.president.gov.ph/news/default.aspx?n=752

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