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10/31/2025

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10/31/2025
LAWIN.news

PhilHealth forms team to investigate outpatient program fraud

by Mae De Vera, LAWIN.news August 29, 2025
written by Mae De Vera, LAWIN.news August 29, 2025
Rey Baleña, acting vice president for corporate affairs group, said the Special Anti-Fraud Unit is tasked to monitor and make people using GAMOT in their illegal transactions liable. Photo Credit: Philstar.com
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The Philippine Health Insurance Corp. (PhilHealth) has initiated an investigation into potential fraudulent activities within its Guaranteed and Accessible Medications for Outpatient Treatment (GAMOT) program. A dedicated team has been assembled to scrutinize individuals or groups exploiting the program.

Rey Baleña, the acting vice president for the corporate affairs group, announced that the Special Anti-Fraud Unit is responsible for overseeing and holding accountable those involved in illegal transactions using GAMOT.

“Our president and CEO, Dr. Edwin Mercado, has set up a special unit to address urgent fraud issues related to GAMOT and other PhilHealth benefits,” Baleña stated.

He further explained that the unit’s focus will include investigating illegal actions associated with various agency programs, such as the Yakap (Yakap sa Kalusugan) program, which includes GAMOT, and pursuing legal action when necessary.

Baleña emphasized the importance of verifying the existence of members registered at Yakap clinics. He noted that registration is facilitated through the egov PH app, which connects with the National ID system for convenience.

He also mentioned plans to enforce strict verification measures at service points to prevent abuse of the program. “We aim to integrate these measures into the system to prevent any form of cheating or misuse,” he added.

Baleña urged members to promptly report any fraudulent activities targeting PhilHealth programs.

Under the GAMOT program, PhilHealth members are entitled to 75 types of medication, totaling up to P20,000 annually.

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Mae De Vera, LAWIN.news

Mae De Vera is a passionate advocate, creative professional, and entrepreneur. A graduate of Political Science from Saint Louis University and a law student of Arellano University, Mae is dedicated to empowering marginalized communities through outreach programs and advocacy. With a background in digital artwork, event flyer design, ESL teaching, and business management, Mae brings a versatile skill set to her endeavors. She also embraces her love for nature through farming, integrating sustainability into her life. Mae’s leadership experience as a consistent school student leader reflects her commitment to making a difference. Today, she combines her creativity, advocacy, and entrepreneurial spirit to create impactful stories and initiatives that inspire change. Disclaimer: The views and beliefs expressed by the author do not necessarily represent those of LAWIN.news, its management, editorial board, or staff.

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