PhilHealth plans to implement an AI-powered pre-validation system to prevent fraudulent health insurance claims and protect its funds.
The system will electronically check if patients’ laboratory tests match their medical diagnoses and flag potentially ineligible claims.
PhilHealth CEO Edwin Mercado said the technology will be rolled out within the quarter for e-claims submissions.
The move responds to recommendations from the Philippine Institute for Development Studies to tighten fraud control measures.
PIDS urged PhilHealth to expand the definition of fraud, strengthen prevention mechanisms, and deter providers from exploiting the system.
Source: PhilNews24 | January 8, 2026
