The "ghost patient
scam" of the Philippine Health Insurance Corp.
The state audit office confirmed the existence of ghost patients
, overutilization of claims and 'upcasing,' which happens when a hospital charges PhilHealth, say, for pneumonia even if the patient only had common cold.
It had been reported that PhilHealth lost as much as P154 billion in funds since 2013 through the bogus kidney dialysis of ghost patients
. This has robbed indigent patients the chance to avail of the treatment.
The NHS Counter Fraud Authority recently launched a national probe into socalled 'ghost patients
', for which practices still get funding even though they may have left the area or died.
The figures suggest GP surgeries in Telford & Wrekin alone could currently be receiving about PS1.9 million for ghost patients
each year, with a similar figure across Shropshire.
According to PhilHealth chief Ferrer, while they address clamors to increase their case rates, they have to deal with unscrupulous providers that defraud the government through upcasing, ghost patients
and fabrication of claims.
Labour MP Meg Hillier, chairman of the Commons' Public Accounts Committee, said as much as PS550 million was being wrongly allocated to GPs with "ghost patients
" on their books.
Investigators are also chasing GPs and dentists who create "ghost patients
" to further con the NHS.
Doctors' magazine Pulse, which uncovered details of the scheme, found thousands of "ghost patients
" have already been inappropriately booted off practice lists in recent years.
She feared the surgery may be receiving payments for ghost patients
The loopholes which were pointed out by the committee are weak supply chain management system including improper record keeping, lack of qualified and trained staff for managing supply chain and recording of ghost patients
(patients who did not actually receive care) or false prescriptions.
These were forged in the names of ghost patients
who did not exist.