GHOST PATIENTS IN Cordillera: “…wala talagang pasyente pero binigyan siya ng medical services… other names belong to dead people” – PhilHealth-CAR Officer

Baguio City, Philippines — While the country continues to grapple with “ghost projects,” where public funds are allocated to infrastructure that never existed, the Philippine Health Insurance Corporation – Cordillera (PhilHealth-CAR) is now investigating a similar issue in the health sector involving so-called “ghost patients.”

PhilHealth-CAR Legal Section Head Atty. Eric Mandiit revealed in the December 1, 2025 Kapihan sa Baguio forum that several names have been recorded as having received medical services despite never visiting any clinic or hospital, while others listed as beneficiaries were later found to be deceased.

According to Mandiit, the agency has received around 1,000 reports of ghost patients in the region, mostly under the first-patient encounter (FPE) of the Konsulta program (now YAKAP) from 2022 to 2024.

The FPE is intended to be a patient’s first medical check-up, for which PhilHealth pays accredited providers a fixed amount of P680 per registered beneficiary. But Mandiit said their findings show that many of those listed did not actually receive any medical services.

“Sa ghost patient, wala talagang pasyente pero binigyan siya ng medical services. The fact is wala talagang ginawa sa patient o walang patient na binigyan ng service,” Mandiit said, as quoted by PIA-CAR.

Aside from patients who never received treatment, PhilHealth also discovered that some accredited primary care providers (PCPs) or YAKAP Clinics claimed FPE payments even though the listed beneficiaries were already dead.

Mandiit said PhilHealth verified this after their legal team visited barangays and checked records with local civil registrars.

“May nakuha kaming report na na-claim ng isang YAKAP provider na may FPE pero patay na. Actually, ‘yan ang isang problema natin. Paano ma-ki-claim ng isang provider na binigyan daw nila ng service na FPE eh in actual, patay na ‘yung patient?” he said, adding that the agency has also received reports of similar “ghost patient” cases in dialysis claims.

If totaled, PhilHealth has lost P680,000 from the 1,000 fake FPE claims alone. The amount may increase as the investigation continues.

In response to the findings, Mandiit said PhilHealth has already filed several cases before its prosecution unit, which has issued letters to the involved FPE providers requiring them to explain how ghost patients appeared in their reports.

Once sufficient evidence is established, PhilHealth will endorse the cases to the Arbitration Department for formal filing.

Mandiit also encouraged FPE members to help prevent fraudulent claims by checking their Benefit Payment Notice (BPN) (sent via text message) to verify whether they actually received the listed services. The BPN reflects all benefits charged to a member’s account.

“We encourage po ang ating mga members or patients. Meron po tayong sinasabi na text BPN, pinapa-confirm po sa inyo if tama ba na nag-avail kayo ng benepisyo. Pero ’pag hindi po nangyari ’yon…hindi ninyo na-avail, hindi kayo na-confine, puwede po kayong pumunta sa aming local health insurance offices,” the Philhealth Officer said.