PhilHealth and NBI collaborate to combat health insurance fraud

“Two are better than one, because they have a good return for their labor. If either of them falls down, one can help the other up.”  Atty. Dante A. Gierran, CPA Philhealth President and Chief Executive Officer highlighted.
The Philippine Health Insurance Corporation (PhilHealth) recently having an ink deal with the country’s leading investigating authority National Bureau of Investigation to go after illicit activities that are potentially defrauding the National Health Insurance Program.  

Both parties have agreed on a shared set of responsibilities to detect, deter, and prosecute fraud committed by health care facilities and professionals, and even those made in connivance with its own officers and employees.
Meanwhile, “Essentially outlines how the Bureau and PhilHealth will work together as a team in combating graft and corruption and in gaining back the trust and confidence of the people in government-subsidized health care system.” Eric B. Distor,  NBI Officer-in- Charge Director cited. 

Under the agreement, PhilHealth may request for investigative assistance from the NBI including surveillance, investigation, and entrapment of violators, if needed. Further, PhilHealth officers and employees may be called on as witnesses for complaints to be filed by the Bureau arising from the investigations. All pertinent records, documents, and information must be turned over by PhilHealth to the NBI to help resolve the cases.
“Respond swiftly and appropriately to a complaint, relevant tip-off, information, and/or lead provided by PhilHealth whether referred by PhilHealth head office or regional office including its legal offices, to determine possible violations.” Gierran added. 
Photo courtesy of Philhealth CorComm
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PhilHealth retained ISO 9001:2015 
 “Despite the ongoing pandemic and the adversities that the Corporation has been confronted (with) for the past years, I’m happy that we (retained) the coveted ISO certification,”  PhilHealth President and CEO Dante A. Gierran emphasized. 
 Simple unveiling rites on last February 15 spearheaded by PhilHealth Chief where officers and employees from all its 17 regional offices nationwide have gathered in a synchronized flag ceremony Philippine Health Insurance Corporation (PhilHealth) has been recertified ISO 9001:2015 after a stringent audit of its quality management system (QMS) conducted late last year.
The ISO 9001 certification is an international quality control management system granted by the International Organization for Standardization (ISO) and is widely recognized as a benchmark for organizations in demonstrating continuous improvement and consistent provision of products and services that meet customer and regulatory requirements.
PhilHealth awarded the certification after going through the remote surveillance audit conducted by third party auditor SOCOTEC Certification Philippines, Inc. last December 16-18, 2020 amid challenges in mobility brought about by the ongoing pandemic.
The said certification including “Public Administration” which consists of the Agency’s processes, member coverage management, benefit delivery, provider management, and management and support processes.
The PhilHealth head recognized the efforts and hard work of the PhilHealth community who have always been the strength and backbone of the state agency, enjoining them to “sustain the efforts that have been made”, adding that “Obtaining the ISO certification needs renewal of commitment. We will continuously raise the bar. We will ceaselessly seek to improve our brand of quality service to the public — consistent with the requirements of the ISO 9001 QMS Standards.”

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PhilHealth pact with AMLC

The Philippine Health Insurance Corporation (PhilHealth) and the Anti-Money Laundering Council (AMLC) in a simple celebration have recently formalized a joint undertaking to “promote and encourage cooperation and coordination to effectively prevent, control, detect, investigate and prosecute unlawful and money laundering activities as well as terrorism financing.”
The partnership also “endeavors to cooperate in the areas of information exchange in accordance with the Data Privacy Act of 2012, and capacity building measures to enhance the capability of both parties in addressing money laundering, terrorism financing and unlawful activities in the country.”
The said contract will help the state health insurer to obtain needed “financial information in relation to any violation of laws that the PhilHealth is tasked to implement which would give rise to the commission of any unlawful activity under Section 3(i) of the Anti- Money Laundering Act of 2001, as amended, and money laundering activities…”
The deal was signed by PhilHealth President and CEO Atty. Dante A. Gierran (2nd from left) and AMLC Executive Director Atty. Mel Georgie B. Racela. Also in photo are PhilHealth Acting Executive Vice President and Chief Operating Officer Nerissa R. Santiago and AMLC Deputy Director Atty. Alvin L. Bermido

MJ Olvina- Balaguer of DZMJ Online, Makabuluhang Jornalismo your happiness channel +639053611058, maryjaneolvina@gmail.com or konekted@dzmjonline.net