Fraud allegations at PhilHealth

The Philippine Health Insurance Corporation announces that the agency has released P500 million as partial payment to the Philippine Red Cross. 

"PhilHealth takes exception to the insinuation that it is reckless and is playing on people’s lives. Its prudence in taking charge of its members’ hard-earned contributions is central to the state health insurer. Its exercise of judiciousness is to protect the people and their funds", PhiHealth President and CEO Dante Gierran says in a statement.

Two committees in the House approve a report recommending the filing of administrative and criminal charges against Health Secretary Francisco Duque III, former PhilHealth chief Ricardo Morales and other officials over the widespread corruption in the state health insurer.

President Rodrigo Duterte says the government will compensate the Philippine Red Cross for COVID-19 tests.

The Red Cross recently halted conducting tests due to the P930 million debt of the Philippine Health Insurance Corporation for the conduct of COVID-19 tests for the government.

"I don't think Sen. (Richard) Gordon would have in his mind to stop. What I'm trying to say is we will pay," Duterte says in a recorded address aired Monday night.

The Philippine Red Cross will stop conducting COVID-19 tests chargeable to PhilHealth due to the state insurer's outstanding balance.

PRC says it will no longer receive specimens for testing of OFWs, those arriving in airports and seaports, individuals through mega swabbing facilities, frontline health and government workers, and others included in the expanded testing guidelines of the DOH.

"The PRC does not have unlimited resources to replenish the testing kits for its laboratories unless PhilHealth, its major creditor, settles its lawful obligations to the PRC," PRC says in a statement dated October 14.

Forty names tagged in the Philhealth controversy are under investigation, says Greco Belgica, chief of the Presidential Anti-Corruption Commission.

Belgica says at a Malacanang press briefing that the 40 names include those of regional officials, executives and directors of the board.

"We will be filing cases (before) the Ombudsman," Belgica says. (Report by The STAR/Alexis Romero)

Task Force PhilHealth has recommended complaints against former PhilHealth CEO Ricardo Morales, Senior Vice President Jovita Aragona, officer-in-charge Calixto Gabuya Jr. over alleged corruption at the state insurer related to overpriced ICT systems and other issues.

President Rodrigo Duterte announced the recommendations at a meeting of the IATF, part of which was televised.

Senate President Tito Sotto reports the findings of the Senate Committee of the Whole following its investigation into alleged anomalies at PhilHealth.

Sotto admits that he is taking the task of reporting the Senate panel's findings with some reluctance in the middle of the COVID-19 pandemic, noting that "we should not change horses mid-stream."

"It is suggested that we must let the pandemic first subside, before advocating for changes, in the areas of leadership, organization, systems and operations of PhilHealth," Sotto says.

Newly appointed PhilHealth chief Dante Gierran admits he is "very scared" of taking over the state insurer.

"I'm scared because I don't know the operations of PhilHealth. Unlike NBI, I knew the operations of NBI but PhilHealth, wala. I do not know about public health," Gierran tells ANC's "Headstart" Tuesday morning.

The former NBI director adds he does not have experience about public health but he knows about financial management.

President Rodrigo Duterte has "stated that it would be best for [PhilHealth CEO Ricardo Morales] and for PhilHealth to give up his post during these critical times for the agency," Justice Secretary Menardo Guevarra says.

Guevarra says the president had noted Morales' health.

The secretary adds that Executive Secretary Salvador Medialdea has already talked to Morales "and that the latter said he would understand if he had to be replaced."
 

Sen. Panfilo Lacson warns PhilHealth President and CEO Ricardo Morales and Senior Vice President Renato Limsiaco Jr. that they may face charges should the alleged irregularities in the state insurer be proven.

"Malamang, maliligo kayo sa kaso kapag ibinahagi na ni SP Tito Sotto kay DOJ Secretary Menardo Guevarra ang lahat na records ng proceedinhs ng pagdinig na sinasagawa namin ngayon," Lacson says.

Lacson recalled that in the previous Senate hearing, Limsiaco admitted that PhilHealth remitted P156 million to the Bureau of Internal Revenue last August 3, claiming that he charged the amount to the Corporate Operational Budget of the agency. 

"Then, he followed up with another lie - that he didn't know that it was an obligation under the law that he had to withhold taxes," the senator says. 

Health Secretary Francisco Duque III enumerates his efforts to counter fraud and corruption during his term as PhilHealth chief.

"I would like to state for the record that I am for zero tolerance on fraud and corruption" Duque tells the Senate Committee of the Whole during its unquiry on alleged corruption in the state insurer.

Duque denies that PhilHealth had P154 billion in losses, points out that the allegedly overpriced IT budhet and procurements are still in the planning phase.

Rep. Stella Quimbo (Marikina) claims that the extent of PhilHealth fraud relating to excess pneumonia ppaayments is estimated at P15.4 billion from 2014-2018.

According to Quimbo, PhilHealth claims for pneumonia totaled 757,266 in 2018 alone, which is more than the estimated number of pneumonia patients based on DOH morbidity data.

"On the average, PhilHealth paid P14,445 per claim in 2018, hence, the value of ghost and upcased claims is estimated at P3.6 billion in 2018," the lawmaker says.

PhilHealth Senior Vice President Renato Limsiaco Jr., who was previously tagged as among the "mafia" inside the egency, defends himself at the Senate inquiry into alleged corruption in the state insurer.

Limsiaco claims former anti-fraud officer Thorrsson Keith started the villification campaign against the agency and himself and that there is no truth to the whistleblower's allegations.

"I respectfully request the Senate to make them (witnesses) accountable for their reckless action and present tangible proof," Limsiaco tells the Senate.

With two of their top officials unable to attend Senate hearings and another resigning from his post, workers at the Philippine Health Insurance Corp. call on President Rodrigo Duterte to name "a caretaker who is an expert in the field of health insurance."

In a statement shared by Bukluran ng Manggagawang Pilipino, PhilHealth Workers for Hope, Integrity, Transparency and Empowerment say the caretaker should also be of "proven integrity and incorruptibility" and is not being investigated in alleged multibillion-peso fraud at the state insurance firm.

"By doing so, all doubts about whitewashing and cover-up would be dispelled," they say.

"There are issues that need to be addressed and resolved decisively and immediately," they say, citing alleged overpricing and other allegations that the Senate and a Department of Justice-led task force are looking into separately.

Senate Minority Leader Franklin Drilon says the Commission on Audit does not object to a proposal for a special audit of the Philippine Health Insurance Corp. in light of alleged fraud involving "ghost" kidney treatments.

"I am glad that COA finds merit in our proposal for a special audit of Philhealth considering the gravity of the situation and the consequences if we fail to address the matter with urgency," he says in a news release.

Drilon says he talked to COA Chair Michael Aguinaldo, who "even recommended an accurate review of the actuarial life of Philhealth." 

Drilon says: "What we have found out so far could just be the tip of the iceberg. We do not know how deep it is. We do not know how far it is and how prejudiced the actuarial life of Philhealth is."

Quezon City Regional Trial Court Branch 219 has dismissed the 17 cases of estafa through falsification of public and/or official documents against the owner and former employees of Wellmed Dialysis and Laboratory Center Corp. in relation to allegedly fraudulent kidney treatments charged to the Philippine Health Insurance Corp.

The court says it has no jurisdiction over the cases filed against Bryan Christopher Wang Sy, Liezel Aileen De Leon, Edwin Corita Roberto, which it says should have been filed before the Metropolitan Trial Court.

"This court is bereft of jurisdiction to take cognizance of the Estafa through Falsification of Public/Official Documents cases which properly pertain to the first level courts," it says.

"Offenses punishable with imprisonment not exceeding six years pertan to the first-level courts," it also says.

The dismissal of the cases are due to the lack of jurisdiction, the court points out, and does not delve into whether the respondents are guilty or not.

The Philippine Health Insurance Corp. is facing scrutiny anew over more allegations of corruption.

It was in the headlines last year because of an alleged scam involving payments to WellMed Dialysis Center for treatments charged for a patient who had already died.

Follow this thread for updates.