Besides amending the UHC law to mandate a PhilHealth audit, Angara also made the following recommendations:
Strengthening of PhilHealth’s anti-fraud mechanisms, including the digitization of its records using systems similar to that of the Government Service Insurance System and the Social Security System . This is to validate members’ benefit claims. A comprehensive review of PhilHealth’s All Case Rates claims payment scheme, including the recalculation of the top 32 case rates that account for more than 90% of claims filed annually
The parallel investigation of the House of Representatives zeroed in on the apparent “up-casing,” in which doctors or hospital operators deliberately misrepresent a patient’s condition in order to claim a higher case rate – for example, common cold as pneumonia.
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