PhilHealth justifies reimbursement scheme

MANILA, Philippines — Phillippine Health Insurance Corp. (PhilHealth) president Ricardo Morales has defended the adoption of the Interim Reimbursement Mechanism (IRM), which is said to be one of the sources of corruption in the embattled agency.

Morales said as the first responders to the COVID-19 pandemic, PhilHealth was prompted to implement IRM and allow hospitals to not immediately liquidate funds.

“Extraordinary times need extraordinary measures,” Morales said, though he clarified that IRM releases are based on the historical claims of hospitals and undergo a process of application, evaluation, validation and recommendation at the level of the regional offices and approval at its head office.

“All transactions on IRM are aboveboard and within the guidelines set by the corporation,” he pointed out.

He said PhilHealth is evaluating IRM fund distribution in areas with high COVID cases such as Metro Manila, Regions III, IV, VII and VIII or where hospital bed capacity either reached full or were at critical levels resulting from increased infection following the easing of quarantine restrictions.

According to Morales, IRM is strictly subject to the usual stringent government accounting and auditing rules and requires reconciliation and liquidation, contrary to reports that hospitals are not required to liquidate their advances.

“Liquidation is definitely a must but since we are in unusual times, we made the timing of liquidation flexible with such options left to the good judgement of the regions, given the situations that hospitals are in,” Morales said.

Morales denied reports that PhilHealth senior vice president for fund management sector Renato Limsiaco Jr. favored certain hospitals or has released the IRM in record time.

Limsiaco’s authority, he said, is limited to vetting the release of funds based on complete documents and does not include determining which hospitals would be given funds.

Morales said some P15 billion has been released to 711 institutions, thus disproving the unfounded claims that Limsiaco abandoned his post during the enhanced community quarantine when he was marooned by the locked down in his hometown in Region VIII.

The IRM funds, Morales said, was offered to all healthcare facilities, including lying-in centers and dialysis clinics, to ensure unhampered health services to all Filipinos.

“It necessitated funds even in facilities with pending cases as long as they were licensed by the DOH (Department of Health). But this is not to say that they will no longer be penalized once proven guilty of any infraction of rules and policies,” Morales noted.

Last May, Morales said PhilHealth revised its strategy in IRM releases by scaling down releases only to areas with high cases of COVID-19 and the presence of government facilities directly handling patients to ensure sufficient funds are available for all citizens needing healthcare.

Morales said the COVID-19 pandemic is not yet over and it is premature to conclude that these hospitals will not be treating infected patients in the weeks or months to come.

“Remember that we have to contain yet the transmission. With LSIs (locally stranded individuals) retuning home en masse, a spike in cases is still a very real possibility,” the PhilHealth chief added.

He said PhilHealth partnership with the Philippine Red Cross (PRC) is pursuant to the Bayanihan We Heal As One Act. The partnership is only temporary.

The advance financing arrangement with PRC, he said, is consistent with the Universal Health Care Act that authorizes PhilHealth to pay providers using performance-driven, close-end, prospective payments.

“We do not have a complete picture yet of the true behavior of this contagion so it is incumbent upon PhilHealth to be agile and swift in decisions to be more responsive to population areas needing support.” Morales said.