PhilHealth probes ‘ghost patients’ in CAR

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December 9, 2025 | 12:00am

BAGUIO CITY, Philippines — The Philippine Health Insurance Corp. or PhilHealth is investigating around 1,000 suspected “ghost patient” cases that involve claims already paid to different health care providers.

Lawyer Eric Mandiit of PhilHealth-Cordillera Administrative Region said some of the cases involve people listed as having used their PhilHealth benefits from 2022 to 2024, even if they never received any medical treatment.

Other cases showed that some patients had died before the dates of the claimed medical services.

Mandiit said Philhealth also discovered double claims, including cases wherein one patient claimed undergoing dialysis in two facilities on the same day.

He said similar cases were detected in the government’s Yaman ng Kalusugan Program.

Initial investigation showed that PhilHealth has already paid about P680,000 of the questionable claims.

The “ghost patient” cases were discovered after some people reported having received text messages that said PhilHealth had paid for their treatments, even when they had not availed themselves of the services.

According to Mandiit, the PhilHealth in the region is strengthening its monitoring and investigation efforts by conducting surprise facility inspections, validating claims through home visits, and sending text alerts to members to confirm benefit usage.

Erring health facilities may face sanctions that include fines and suspension of accreditation.