A legacy of honor

In the aftermath of a whirlwind of events that have shaken the Philippine Health Insurance Corp. (PhilHealth), one truth shines through: PhilHealth is actually in a better shape, and the PhilHealth Fund is safer and more secure.

And Dr. Roy Ferrer, the unflappable acting PhilHealth president and CEO stands out unscathed from a bruising bout in a media campaign run by unseen hands, and has remained untainted by any hint of corruption. 

(Dr. Ferrer filed his resignation only the other day to clear the way for President Duterte to implement a revamp.)

It should not escape anyone that no less than the President – on television – declared: “I never had reason to doubt the integrity and honesty of PhilHealth president Roy Ferrer.”  May I add that Dr. Ferrer has left a legacy of professional competence, integrity and honor in PhilHealth.

Amidst many issues surrounding the dizzying developments in PhilHealth, I wish to focus on this one official whose only desire was to protect the Fund that assures millions of patients of financial support, and whose only imperative is to cleanse PhilHealth of graft inside and outside the state insurance agency.

A little over a year ago, on June 5, 2018 to be exact, President Duterte appointed Dr. Ferrer as acting president and CEO of Philhealth, replacing a fellow member of the PhilHealth Board. Dr. Ferrer, as CEO, hit the ground running and immediately ordered a reshuffle of regional vice presidents, as the remarkable start of the cleansing process. 

At the same time, he led the newly constituted PhilHealth Board to be ready for the passage of the Universal Health Care Law, since such piece of legislation will make a deep impact on the ability of the government to make sure health services will benefit 100 percent of the Filipino population which has breached the 100 million mark.

Aware of  the responsibility to ensure that PhilHealth is financially stable, Dr. Ferrer deployed the five-point resiliency plan – to wit: (1) strengthened accounts management; (2) premium increase; (3) reasonable benefit payouts; (4) prudent spending; (5) stronger anti-fraud campaign.

As a result, PhilHealth’s net income for 2018 increased by about 4,800 percent when the restated 2017 net income of P237 million ballooned to P11.616 billion in 2018.

The trend continues in 2019. As of March, PhilHealth has now posted a net income of P2.439 billion, an increase of P1.176 billion over March 2018’s P1.263 billion net income.

As of this writing, the PhilHealth Fund stands at P127 billion, and this will be augmented by P17 billion more from PCSO and PAGCOR, as well as by the increase in rates and Sin Tax when the Universal Health Care Act is fully implemented.

To further protect the Fund, Dr. Ferrer has deployed teams for a corporate-wide intensive fraud detection and enforcement activities that, as he put it, “will catch the thieving, deceiving, and villainous officials and their band of brothers among hospitals and other healthcare facilities.” 

The PhilHealth CEO was not lacking in political and managerial will to enforce the laws and harness the resources and networks available to him. 

Dr. Ferrer had no illusions of the challenges facing him, and he is fully aware of the members of a few syndicates which are made up of cheating, disloyal, and disgruntled PhilHealth officials who have colluded with hospitals and other health care facilities in the cities and countryside. 

He focused on major problems in the Visayas and Mindanao, marked by collusions between top PhilHealth regional officials and big hospitals. The ghost dialysis case against WellMed Dialysis Center is not really  that big, according to reports, so he delegated  probe of the case to his subordinates.

Already, in coordination with the National Bureau of Investigation and other enforcement agencies, these syndicates would have started disintegrating. It is now the job of the new PhilHealth president and the new Board to sustain the anti-fraud campaign began by Dr. Ferrer.

As of this writing, those found to have defrauded PhilHealth of funds have already been suspended, others are being investigated, a few others will soon be charged in court for criminal offenses.

Aside from sustained enforcement operations conducted outside PhilHealth, Dr. Ferrer led his team to put up a policy regime that strengthens internal systems and procedures that are fool-proof.

PhilHealth also instituted a medical prepayment review where all claims are assessed first of the patients’ or hospitals’ compliance with existing policies and standards on quality care.  

The policy requires hospitals to submit the Claim Form 4 that immediately  enables  the agency to detect irregular practices – like over utilization or under-utilization of services, needless use of diagnostic and therapeutic procedures and interventions, and irrational medication and prescriptions.

 PhilHealth also has a policy to detect fraudulent, false or incorrect information, deviations from currently accepted standards of practice and treatment protocols, inappropriate referral practices, use of fake, adulterated, misbranded or unregistered drugs; among other attempts to cheat.

 Aside from intensified investigations, he stepped up spot checks of health care providers. Under his watch, PhilHealth set up a dialysis database, validation of multiple claims and of deceased patients. PhilHealth also adopted the Machine Learning Identification, Detection and Analysis System (MIDAS) that analyzes voluminous claims data to detect over utilization. 

As a result, in the first quarter of 2019 alone, the state health insurer has decided on 34 cases against 14 facilities and professionals; and is currently hearing 4,419 cases more. As of April this year, it also reported completion of 1,432 investigations even as it continues investigating close to 9,000 more reports of fraudulent activities where the highest numbers of cases come from Calabarzon, Northern Mindanao, and Davao regions. 

In one of his more recent statements, Dr. Ferrer declared that “under the Duterte government and under my watch, PhilHealth will move forward with uncommon courage and conviction, to fulfill the mandate of the Universal Health Care Law, to make a weak-kneed PhilHealth a thing of the past, and to assure a stronger PhilHealth as a present reality.” 

Dr. Roy Ferrer has surely left a stronger health insurance institution, and is leaving with the trust and confidence of President Duterte of his honesty and integrity. Those who know Dr. Roy, who felt his passion to leave a legacy of a stronger and more responsive PhilHealth, knows that this CEO has given his word to his job exceedingly well. He has honored such word.

 The government’s loss is the private sector’s gain. At any rate, you will find Dr. Ferrer in his many medical commitments in Davao and elsewhere, doing things he does best: bringing back people to great health and still providing competent and committed leadership to medical associations and civic organizations for a healthier and stronger nation. 

The country owes this honest and honorable man a debt of gratitude.

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In last week’s column, I  wrote about a trip  Tess Tumangan and I took to the Bukid Amara flower wonderland in Lucban, Quezon. Tess is an active Rotary Club of Manila 101 (not 109) officer. Incidentally, Tess and her colleagues have long appointed me an honorary Rotary  member.

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Belated greetings to Cleofe (Bebe) Ranque, wife of Energy Undersecretary Benito Ranque, who celebrated her birthday last week in her home in  Portulin, Medina, Misamis Oriental.  Portulin has a 1,400 population, and Medina, 24,000. The sumptuous lunch Bebe prepared was also a victory party, as she was elected in the May 2019  election as the only woman member of the seven-man Medina municipal council. Mother of five, Cleofe was previously a barangay kagawad. As a municipal council member, she told me she will be focusing on women’s issues, like health, livelihood, education and the environment

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