Philhealth infographic about hospital ‘upcasing’ raises eyebrows

August 25, 2021 - 6:16 PM
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PhilHealth
Undated photo from PhilHealth's website. (Photo from PhilHealth)

The state insurer issued an updated version of its campaign against “upcasing” after it received criticisms from some members of the medical community.

The Philippine Health Insurance Corporation had previously warned the public against the scheme involving some doctors allegedly extorting money from patients.

“Ang ‘upcasing’ ay pakikipagsabwatan ng mga duktor at pasilidad sa pasyente para madeklara ang simpleng sakit sa mas malalang klasipikasyon nito para makakuha at makasingil ng mas mataas na benepisyo sa PhilHealth,” read the infographic posted July 30.

“Ito ay isang uri ng health insurance fraud na maituturing na isang krimen na may karampatang multa at kaparusahan na pagkabilanggo,” it added.

PhilHealth also listed steps with the acronym “ASTIG” to identify and report incidents:

  1. Alamin ang karaptan mo bilang miyembro.
  2. Suriin ang statement of account at kumpirmahin ang mga detalyeng nakuha.
  3. Tanungin ang duktor.
  4. I-report kung may kaduda-dudang Gawain.
  5. Gawin ito ng tama. Maglakip ng karampatang epidensya.

On August 14, PhilHealth posted the same advisory against upcasing. However, it removed the “ASTIG” method in the infographic.

It added that perpetrators will be fined P200,000 for each case and face suspension of contract and imprisonment of up to six years as provided under Republic Act 1132.

Unnecessary witchhunt

Some social media users who saw the first infographic perceived that the five-step ASTIG process could spiral into a witchhunt on doctors and health care workers.

Carlo Trinidad, known online as the Kidney Doctor, expressed this concern on Twitter.

“Unfortunately there are rotten eggs in every profession. But I feel the infographic could have been done better. They risk sending the wrong message and end up antagonizing the overwhelming number of good doctors who do not ‘upcase’,” Trinidad said.

But it’s not only doctors. Some patients, due to lack of funds for medical expenses, are involved in this activity, another social media user pointed out.

“Excuse me sino dito ang lumapit na sa doctor nila para baguhin ang diagnosis sa chart para macover ng HMO at Philhealth?! Abeer? Sino dito ang nagpapapangalan ng reseta sa senior na kamaganak para magkadiscount ang meds?” the Twitter user wrote.

Others argued that PhilHealth is passing or shifting the blame of its allegedly mismanaged funds to health care workers.

The state-run corporation has been mired by a string of corruption allegations worth billions of pesos since last year.

“Itataya mo ang lisensya mo at reputasyon para sa dagdag na 1k pesos na makukuha mo pa in 6 months? Or minsan more than 1 year? Namismanage kasi nila ang pondo kaya shifting blame sila ngayon,” one social media user said.

“The audacity of this agency to shift the blame on people. Mas ikauubos ng pondo for healthcare sa mismanagement at korupsiyon,” another user said.

Last week, a circular from PhilHealth against insurance fraud earned the ire of the Private Hospitals Association of the Philippines (PHAPi), the biggest organization of hospitals and physicians in the country.

The circular informs all accredited providers and other stakeholders that the insurer will temporarily suspend payment of claims of hospitals and health care workers being probed for fraud.

PHAPi reacted with a threat to cut ties with Philhealth, citing “feeling of mistrust” between the insurance company and the providers.

“The bridge is bound to collapse. Maybe it is time to review the engagement with PhilHealth and level the playing field,” read the statement signed by PHAPi president Jose Rene de Grano, PHA president Jose Almora and PMA president Benito Atienza.