PhilHealth limits number of cataract procedures that eye clinics and doctors can perform

PhilHealth President and CEO Alexander Padilla (Photo courtesy of OPAPP)

MANILA – The Philippine Health Insurance Corporation (PhilHealth) is now limiting the number of cataract procedures that can be performed by doctors and eye clinics.

According to PhilHealth President and CEO Alexander Padilla, the limit set for a cataract doctor to claim his fees is 50 patients every month.

Atty. Padilla said that limiting the number of procedures that can be performed by a cataract surgeon is a way to prevent the repetition of the case of a doctor who performed cataract surgeries with claims reaching PhP36 million.

Padilla warned that in case a doctor will exceed the limit, they will not be paying the reimbursement claim.

“They have to wait until such time (the following month or other months) to perform the next surgeries. We will not be liable to pay if they exceed,” he stressed.

The PhilHealth chief made the announcement in the midst of the investigation on the alleged “fraud” committed by some eye clinics claiming high amounts of reimbursement for the cataract procedures conducted on patients.

Based on the allegation, the perpetrators of the irregularities used “patient seekers” who convinced senior citizens to undergo eye check-up or cleaning as a deception.

As a result of such deception, most of the patients who were brought to eye centers were performed with cataract surgery without their knowledge and some had even resulted in lost of eyesight.

The Senate Blue Ribbon Committee chaired by Senator Teofisto Guingona III conducted an inquiry into the alleged fraudulent claims on Wednesday, wherein owners of the eye centers involved as well as PhilHealth and Department of Health (DOH) officials were called to testify and give explanations.

During the hearing, the PhilHealth chief said that based on the post-audit they conducted, they have stopped payments of the benefit claims of the eye clinics under investigation.

Another Senate investigation on the issue is set next week.