Whistleblower accuses PhilHealth execs of stealing P15 billion through fraud schemes

This undated photo shows members lining up for PhilHealth benefits at an unnamed hospital.
The STAR/File

MANILA, Philippines — Former Philippine Health Insurance Corp. anti-fraud legal officer Thorrsson Keith on Tuesday alleged that executives of the state-run agency have stolen P15 billion from its funds.

"What we found at PhilHealth is the crime of the year due to the syndication of the distribution of cash advance, the interim reimbursement mechanism, and the repeated overpricing of purchased IT equipment," Keith told the Senate in Filipino.

According to Keith, the agency made unwarranted claims payments to select private hospitals amounting to hundreds of millions of pesos.

The anti-fraud legal officer's resignation, which cited "widespread corruption" within the agency, prompted the Senate, the House of Representatives and Malacañang to launch its own investigations into the matter.

COVID-19 response

As the Senate launched its own probe on Tuesday, Sen. Ping Lacson alleged that the agency's interim reimbursement mechanism, which is meant for healthcare institutions hit by calamitous or "fortuitous events," was not being released to the appropriate hospitals.

According to the senator, PhilHealth released "hundreds of millions" to dialysis centers and maternity care providers but could not release P19 million to the Ospital ng Maynila which was accepting COVID-19 cases.

Meanwhile, he flagged that the agency released P45 million in funds to Braun Avitum Philippines, a company of dialysis centers.

PhilHealth President and CEO Ricardo Morales defended this by saying that the company was turning away patients due to a lack of funds.

Lacson, however, refuted this, saying the funds should not have been taken from the Interim Reimbursement Mechanism (IRM), which is meant for calamities.

PhilHealth officials said that P14.97 billion of the P30 billion allocated budget for the IRM has been released as of July 31.

The Ospital ng Maynila has since been temporarily closed due to a surge in COVID-19 infections among its staff.

Alleged overpricing in IT budget

PhilHealth board member Alejandro Cabanding also accused Morales of pushing for the endorsement of overpriced information technology budget items which he says amount to at least P750 million.

"There were numbers in the IT budget in financial reports that do not add up. I brought it up with the board but the most frustrating part is the management seems to be tolerating such acts," Cabanding said.

Morales, in his opening statement said that PhilHealth's fraud index is at 7.5%, amounting to P10.5B potentially lost to fraud.

However, he defended the agency, saying that "there is no health system in the world that is entirely fraud-free."

According to Morales, a robust information management system will aid in weeding out fraud within the agency.

"PhilHealth's allegedly overpriced P2.1 billion It program over three years is paltry compared to the tens of billions of pesos lost to fraud every year," he said.

As these new allegations of corruption are brought to light, the country continues to grapple with a surge in COVID-19 infections and the longest community quarantine in the world.

The Department of Health on Monday placed the national caseload at 106,330 and fatalities at 2,104. 

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