Resource persons bare fraudulent PhilHealth schemes

MANILA, Philippines — Some doctors are allegedly involved in the reported corrupt practices at the Philippine Health Insurance Corp. (PhilHealth) along with some hospitals and banks that allegedly served as remittance centers for the anomalous transactions, the “Task Force PhilHealth” revealed yesterday.

Department of Justice (DOJ) spokesman Usec. Markk Perete said that two anonymous sources formerly connected with PhilHealth spilled the beans on the alleged fraudulent schemes at the corporation during the task force’s first investigative meeting on Friday afternoon.

The meeting lasted more than five hours.

“The individuals (who requested anonymity) informed the task force of the different fraudulent schemes allegedly employed through the years by PhilHealth officers and employees, both at its main office and regional offices, in collusion with some doctors and hospitals, and even banks which act as remittance centers,” Perete said.

He said the schemes include the payment of false or fraudulent claims against the corporation, malversation of premiums and the exploitation by some unscrupulous personalities of the case rate system and the interim reimbursement mechanism, among others.

Perete added that the witnesses also highlighted the alleged abuses and flaws in the PhilHealth’s legal department and information technology office, that allegedly allowed the proliferation of the fraudulent schemes.

DOJ Sec. Menardo Guevarra, who leads the task force, said that they will conduct “fresh investigations” on the PhilHealth mess, that are not the subject of any ongoing investigation or audit, after learning of the involvement of third parties.

“We’ll focus on identified centers of fraud and certain regional PhilHealth offices that have been notorious for years. We’ll collaborate with the legislative committees conducting probes in aid of legislation to speed up our work and avoid unnecessary duplication, so that we may take legal action immediately,” Guevarra said.

“Lastly, lifestyle checks on past and present PhilHealth officials, whose names have been repeatedly mentioned by witnesses and resource persons, have begun and will eventually be tied up with the anti-fraud and anti-graft investigations,” he added.

Guevarra said that the task force will expedite the completion of the investigations on special audits and resolution of any pending cases pursuant to the 30-day period given to them by President Duterte.

But he said that they will immediately conclude the investigation as soon as they get enough evidence to build up and file cases with the Office of the Ombudsman, “without prejudice to the conduct of further investigation as may be directed by the President.”

The task force is composed of the DOJ, Office of the Ombudsman, Commission on Audit, Civil Service Commission, Presidential Anti-Corruption Commission, Office of the Special Assistant to the President, Anti-Money Laundering Council, National Bureau of Investigation and the National Prosecution Service.

Budget review pushed

Deputy Speaker Loren Legarda urged the joint committees on public accounts and good government and public accountability to expand its investigation on PhilHealth anomalies to include how the state insurance firm spent its budget in previous years.

The Antique representative specifically sought scrutiny on the 2017 and 2018 budgets of the agency, which were augmented upon her initiative when she was still a senator.

“As former chair of the Senate committee on finance, I sponsored the augmentation of the PhilHealth budget by P3 billion under 2017 GAA to ensure that health services are also extended to indigent non-member patients through a Point of Service (POS) program. I continued this under the 2018 budget for the same amount, and even included another P3.5 billion specifically for government employees because the health of the public deserves to be on top of government priorities,” Legarda recalled in a statement.sector

“I urge the House committees to dig deeper and expand their inquiry into the status of these amendments. The augmentations were supposed to cover all Filipinos, even those not yet enrolled in PhilHealth, those not formally employed and those financially incapable to pay their membership contributions can still avail of free health services in government hospitals in the country,” the legislator stressed.

Legarda, principal author and sponsor of Republic Act No. 10606 or the National Insurance Act of 2013, explained that the augmentation of PhilHealth budgets in 2017 and 2018 was meant to help fulfill the spirit of the law which was to ensure universal healthcare coverage for all Filipinos.

PhilHealth was given P50 billion in budget in 2017 and P54.1 billion in 2018.

Legarda lamented the reported misuse of PhilHealth funds, saying it is “unconscionable especially during this time of the pandemic when the health of the people is on the line.”

“It is intended to be a mandatory healthcare for the poor as everyone deserves to receive proper healthcare. I hope that these benefits have been made known to the poorest households who are the intended beneficiaries. This ongoing investigation will hopefully exact accountability from the concerned officials,” Legarda pointed out.

The House joint panel is set to continue its hearings on the PhilHealth anomalies tomorrow.

The heads of the two committees have already said they see possible plunder charges against officials of the agency involved in the alleged anomalies.

Public account committee chair Mike Defensor and good government and public accountability chair Jonathan Sy-Alvarado said officials involved in the PhilHealth “mafia” should be accountable for billions of funds lost to corruption.

“Once evidence are consolidated and we find basis, we will recommend plunder charges against those involved in corruption in PhilHealth,” Alvarado told The STAR in a text message.

IRM is ‘above board’

PhilHealth underscored yesterday that the Interim Reimbursement Mechanism (IRM) is not only to cover COVID-19 patients.

In an interview over dzBB, PhilHealth vice president Shirley Domingo said accredited healthcare institutes can also avail of the IRM for their overall response to the pandemic.

“IRM is for the overall response to COVID and not only for the benefit payment of patients,” she noted.

In an earlier statement, Philhealth said that IRM releases are “above board.”

“Extraordinary times need extraordinary measures,” maintained PhilHealth president and chief executive officer Ricardo Morales, citing that the state insurer was one of the first responders in this pandemic through IRM, an assistance program.

Morales pointed out 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 PhilHealth regional offices and approval at its head office.

During the Taal eruption, the agency had also released IRM assistance to health facilities affected by the calamity.

IRM is provided for under PhilHealth CIrcular 3 s-2013 on the provision of assistance to those affected by a forfeiture event.  – Edu Punay, Sheila Crisostomo