PhilHealth-CAR probes alleged ‘ghost patient’ claims

BAGUIO CITY (PIA) – The Philippine Health Insurance Corporation (PhilHealth) Cordillera is thoroughly investigating reported cases of “ghost patients” in the region, a situation in which fraudulent claims may have been made for individuals who did not actually receive medical treatment.
PhilHealth-CAR Legal Section head Atty. Eric Mandiit shared that they have received around 1,000 “ghost patient” cases in the region, mostly related to the first-patient encounter (FPE) of the Konsulta (now Yakap) from 2022 to 2024.
“Sa ghost patient, wala talagang pasyente pero binigyan siya ng medical services. The fact is wala talagang ginawa sa patient o walang patient na binigyan ng service,” Mandiit said during the Kapihan sa Baguio on December 1, 2025.
He noted that based on their initial data, some service providers have claimed the FPE from PhilHealth but the member or patient is already dead. He said that they have confirmed some of these cases through visitation to barangays and data requested from local civil registrars.
“May nakuha kaming report na na-claim ng isang Yakap provider na may FPE pero patay na. Actually, ‘yan ang isang problema natin. Paano maki-claim ng isang provider na sinabi niyang binigyan ka ng service na FPE eh in actual, patay na ‘yung patient,” he shared.
Mandiit said that they have also received reports of “ghost patient” cases in dialysis coverage.
He said they have already filed several cases with their prosecution department, which has issued letters requesting explanations from the concerned service providers. He said that once there is enough evidence, the case will be forwarded to their arbitration department for the formal filing.
He reminded the patients or PhilHealth members that upon receiving a Benefit Payment Notice (BPN) through text, they should verify if they actually received the stated benefit. If not, they are encouraged to report the matter to the nearest health insurance offices.
“We encourage po ang ating mga members or patients. Meron po tayong sinasabi na text BPN, pinapa-confirm po sa inyo if tama po ba na nag-avail kayo ng benepisyo. Pero ‘pag hindi po nangyari yun, yung sinend namin na message, hindi ninyo na-avail, hindi kayo na-confine, puwede po kayong pumunta sa aming mga local health insurance offices,” Mandiit said.
He also reminded the health care providers to ensure that claims are accurate and truthful.
“Sa ating healthcare providers or facilities, please ensure naman po na tama ang ating kini-claim para rin hindi tayo magkaroon ng problema in the future,” he said.
The FPE is a one-time initial health screening where a primary care provider takes or updates the basic health data to identify health risks. The service is free for PhilHealth members who registered with accredited Konsulta [now Yakap] providers. PhilHealth then pays the accredited provider a fixed amount of P680 for each registered beneficiary who completes an FPE. **DEG-PIA CAR