COA flags P8.27 billion PhilHealth payments for COVID-19 tests

MANILA, Philippines — The Commission on Audit (COA) has flagged the Philippine Health Insurance Corp. (PhilHealth) over questionable payment of a total of P8.278 billion to a private contractor for supposed conduct of 2,481,939 reverse transcription-polymerase chain reaction (RT-PCR) tests from April 2020 to May 2022.

In its 2022 annual audit report on PhilHealth, the COA said the payment was released to the partner contractor (PCr) despite lack of duly accomplished Case Investigation Forms (CIFs), which must contain the patient’s information as well as acknowledgement that he or she underwent the RT-PCR test.

The COA noted that the issue of incomplete documentation of claims for RT-PCR testing was already communicated to PhilHealth in the 2020 and 2021 annual audit reports.

“Despite having the audit issue raised in the previous audits emphasizing the necessity of the submission of the CIFs, 100 percent of the forms remain either partially or not fully filled out,” the COA said.

The COA said that because of the lack of duly accomplished CIFs, “the propriety and occurrence” of claims paid to the PCr “could not be reasonably established.”

The contractor, however, was not identified in the audit report.

Nonetheless, the audit report showed that the payment was released through PhilHealth’s Interim Financing Mechanism (IFM) program.

The IFM program became controversial at the height of the COVID-19 pandemic as Congress investigation revealed that several health care centers and clinics granted with the funds under the IFM did not actually cater to COVID-19 cases.

The COA said that while PhilHealth claimed that it had already communicated with the contractor on May 23, 2022 regarding the submission of the “duly accomplished and signed” CIFs, “no new submission has been made since then.”

The COA recommended to PhilHealth to “prioritize the submission of properly completed CIFs” to avoid state auditors issuing a Notice of Suspension or Notice of Disallowance that would compel the return of the disbursed amount.

“Additionally, considering the increased availability of RT-PCR testing services in various health facilities and laboratories since the beginning of the pandemic, (PhilHealth) Management should reassess the need for continuing the contract with the PCr,” the COA added.

In a reply, PhilHealth said the PCr had already agreed to attend a facilitated dialogue with the audit team “to lay out the challenges encountered in obtaining fully completed CIFs, including patients’ signatures, which is substantial to address the noted findings and recommendations.”

“Considering the ongoing fraud audit of PCr claims conducted by the Audit Team, it is suggested that the Fraud Audit Team also be invited to the dialogue to appropriately validate the challenges encountered in relation to management compliance,” the COA said in a rejoinder.

Meanwhile, a majority of the recently sequenced COVID-19 samples from July 26 to Aug. 1 were classified as Omicron subvariant XBB, the Department of Health reported yesterday.

Of the 767 samples, 647 were XBB subvariant cases. Of these, two were returning overseas Filipinos while the rest were local cases from all regions except Western Visayas. — Rhodina Villanueva