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.
