EDITORIAL - Bleeding PhilHealth dry

Will there ever be an end to the corruption scandals plaguing the Philippine Health Insurance Corp.? Over the past six years alone, PhilHealth has been rocked by accusations of fraudulent payments involving billions of pesos for fake hospitalization and medicine for indigent and elderly patients, cataract surgery and pneumonia.

The latest scandal involves PhilHealth payments allegedly for “ghost” or non-existent kidney dialysis and related treatments. The money is believed to have gone to the pockets of a network of crooks in the state health insurance firm together with certain hospital administrators and medical professionals.

Congressional probes have been conducted and PhilHealth has undertaken internal investigations. Yet here we are again, with the latest scandal involving kidney treatments that are said to have cost taxpayers billions more. Public health care is pitifully inadequate and those billions could have gone a long way in providing urgent medical services particularly to the poor.

Previous scandals should have led to reforms in promoting fiscal prudence within the agency. The scandals should have also led to the prosecution and conviction of anyone found misusing PhilHealth funds. Last year the interim head of the agency, Celestina Ma. Jude de la Serna was fired – but for alleged excessive trips and mismanagement rather than in connection with fraudulent claims.

Institutional reforms should include boosting the capability of PhilHealth to detect fraudulent claims. This gains urgency with the expansion of PhilHealth coverage to include more members as well as illnesses and medical procedures. PhilHealth needs expert advice not only to thwart fraud but also to ensure that those who cheat the government will face appropriate punishment.