IC issues cease and desist order vs Caritas Health due to fraud

MANILA, Philippines — The Insurance Commission (IC) has ordered the health maintenance organization Caritas Health Shield Inc. to stop selling and transacting new HMO products and businesses due to alleged fraud.

In a statement Wednesday, the regulator said Insurance Commissioner Dennis B. Funa last July 8 issued the cease-and-desist order against Caritas Health following “numerous complaints received by the IC on the alleged fraudulent swiping of credit/debit cards and alleged misrepresentations of the company’s sales agents.”

Prior to the order, Funa asked Caritas Health to explain why it should not be meted a cease-and-desist order, such that the company responded that it had “already instituted and implemented various action plans to address said instances of unauthorized swiping of credit or debit cards and misrepresentations.”

However, the IC said Funa was “unconvinced by the explanation given by Caritas Health” as the company itself “acknowledged that there have been instances of unauthorized swiping and misrepresentations committed by its sales agents.”

“The IC’s continuing receipt of numerous complaints against Caritas Health from the general public demonstrates the prima facie inadequacy and unresponsiveness of the company’s action plans,” Funa said.

“It should be stressed that the use of credit and/or debit cards as a mode for payment is not the main problem under the circumstances, but the unethical conduct of Caritas Health’s erring agents/sales associates as well as the apparent lack of timely and effective supervisory intervention by Caritas Health management,” the IC chief added.

Funa said that under Executive Order No. 192, the IC has the power to issue orders that will “prevent fraud and injury to the HMO plan holders and industry stakeholders,” referring to the EO in 2015 that transferred the regulation and supervision of the HMO sector to the IC from the Department of Health (DOH) previously.

As such, the IC was “not precluded from enforcing prompt corrective regulatory action and addressing Caritas Health’s problem with its unscrupulous agents/sales associates at this juncture before it progresses into an uncontrollable state,” according to Funa.

“It will be utterly preposterous and a patent disservice to the general public and the HMO industry if [the IC] will sit idly by and wait until more complaints are reported before taking action,” he added.

Funa nonetheless ordered Caritas Health to continue honoring its existing contracts with members while also providing “uninterrupted” services to plan holders.

The IC chief will appoint an overseer to ensure that Caritas Health will comply with his directive.

To recall, the IC in 2017 also issued a show-cause order against Caritas Health due to similar complaints against its sales agents. (Editor: Mike U. Frialde)