Baguio City (PIA) — PhilHealth-Cordillera is cracking down on fraudulent claims made under the new YAKAP (Yaman ng Kalusugan Program), particularly those involving deceased individuals.
Regional Vice President for CAR Dominga A. Gadgad shared in a Kapihan sa Baguio forum that the YAKAP program, which is designed to provide comprehensive primary care services to all Filipinos, is facing challenges with claims filed under the names of deceased individuals.
Gadgad revealed that PhilHealth, in coordination with the Philippine Statistics Authority (PSA), identified over 1,000 such cases in the Cordillera region.
“That data actually came from central office, in coordination with PSA Central Office,” Gadgad stated. “Nagbigay sila ng mga listahan ng patay, so what PhilHealth did was to reconcile with our data also.”
PhilHealth’s legal team is actively investigating these cases, coordinating with local civil registrars to confirm the deaths and dates.
“Our team conducted thorough validation. We coordinated with local civil registrars to confirm death details, visited families of the listed individuals, and even checked cemetery records to verify burial dates. All cases we reviewed were confirmed to be deceased, yet FPE claims were filed in their names,” Gadgad said.
Facilities found to have submitted claims for deceased members will face legal action, Gadgad said. She expressed disbelief that medical professionals would file First Patient Encounter (FPE) claims for individuals who are already deceased.
“Iyong group natin, pinuntahan iyong pamilya; at pinuntahan pa iyong sementeryo, makikita mo doon kung kailan namatay. But anyway, lahat ng pinuntahan natin ay validated na patay sila, so even the facilities that submitted the claims for that ay informed na po. And we are filing cases against them; and we have to justify kung anong nangyari, kasi I told doctors, MHOs regionwide, I cannot really imagine you indicating First Patient Encounter for those na patay,” she elaborated.
To curb similar incidents, PhilHealth-CAR has implemented key safeguards. The PhilHealth Check utility now allows individuals to perform a “liveness check” to confirm their active status in the system, ensuring no one is listed as alive when they have passed away.
Additionally, the new YAKAP requires a Mutual Care Agreement between members and accredited clinics. This agreement includes verification steps to ensure only living individuals can avail of health services.
“Warnings have been issued to all rural health units in the region to strictly adhere to our guidelines. We are committed to protecting PhilHealth funds—these are public resources meant to serve all Filipinos,” Gadgad said.
The regional office is awaiting explanations from involved facilities before determining final penalties, which may include fines, suspension, or revocation of accreditation. **JDP/MAWC-PIA- CAR
