THE Presidential Anti-Corruption Commission (PACC) said on Tuesday the Philippine Health Insurance Corporation (PhilHealth) continues to lose P2 billion to P3 billion per week due to corruption.
PACC Commissioner Greco Belgica made the statement during his testimony at the second hearing of the Senate Committee of the Whole on alleged anomalies in the state-run health insurer.
“Even while we are here in the hearing, the stealing of money [in PhilHealth] continues since the system is still not changed and people involved, except those removed by the President, remain there,” Belgica said.
He attributed the persistence of anomalies within the agency to its vulnerable information technology (IT) system and slow process of filing cases against erring medical facilities.
The PACC official noted that the lack of a “validation mechanism” for the data input in PhilHealth’s IT system makes it susceptible to manipulation by rogue employees and medical facilities.
Belgica said PhilHealth would have no need for additional funding from the national government if it had addressed both issues by setting up a validation system for its IT and decentralized its filing of cases to its regional offices.
Also at Tuesday’s hearing, Senate Majority Leader Miguel Zubiri zeroed in on “fraudulent transactions,” listing questionable rebates, ghost patients, as well as “legal and administrative cases.”
At the start of the Senate Committee of the Whole hearing, Senate President Vicente Sotto III reminded PhilHealth officials and other witnesses they were testifying under oath, indicating they could be held liable for perjury.
Long process
Meanwhile, Belgica blamed PhilHealth’s long process for filing cases, which needs to go through the central office, as the main reason why there is few or no case filed against erring hospitals.
Belgica said many PhilHealth official and personnel are aware of these gaps and have used them to perpetrate illegal activities, such as filing claims for “ghost” patients or resorting to upcasing—here, a simple prescription for a hypertensive patient may be levelled up and written as a mild stroke, in order to claim higher rates.
PACC vowed to go after not only the erring top officials of PhilHealth, but also its rank-and-file workers involved in anomalies, and then sue them before the Ombudsman.
In a related development, Malacañang said there will be a status quo on the leadership of PhilHealth until the task force created to investigate its alleged anomalies submits its report to President Duterte.
Presidential spokesperson Harry Roque said the President may only consider changing the leadership of the agency upon the recommendation of the task force led by the Department of Justice.
PhilHealth President and CEO Ricardo Morales and other PhilHealth officials are under investigation from the task force due to PhilHealth’s alleged overpriced purchase of P2 billion worth of IT items, among others.
Favoritism in IRM?
Taking his turn, Zubiri bared a list of assorted anomalies, giving Senate probers a rundown of PhilHealth’s “history of corrupt practices, ranging from unreleased Interim Reimbursement Mechanism (IRM) funds to nonexistent and ghost patients,” as well as “questionable legal and administrative cases within PhilHealth.”
While reports cited cases of hospitals getting hundreds of millions in IRM funds even though they hardly handled Covid cases, Zubiri said some critical public institutions like Ospital ng Maynila have yet to receive IRM funds (P19.3 million in the latter’s case). PhilHealth likewise failed to act on the IRM fund applications of at least two other government healthcare institutions, also handling Covid-19 cases—the Western Visayas Medical Center in Iloilo City that reported P121.4-million unreleased IRM funds and the Corazon Locsin Montelibano Memorial Regional Hospital in Bacolod that, Zubiri said, was “still waiting” for the release of P41.7-million IRM.
Zubiri likewise lamented what he found to be the troubling phenomenon of nonexistent and “ghost patients.”
Zubiri also raised the case of Golingay General Hospital in Malalag, Davao del Sur, as “a prime example of the nonexistent patient scheme,” after finding out that the infirmary, with an 18-bed capacity, was “paid P18 million in claims in 2014, and almost P10 million in just the first semester of 2015.”
Without guidelines
Sen. Panfilo Lacson questioned the dubious release of multibillion PhilHealth funds “without guidelines,” noting the subsequent release of another P9.3 billion.
“What are the guidelines for release without an IRR for guidance?” Lacson asked, adding, “How can they release funds without IRR?”
The senators, however, were informed by PhilHealth officials that they were “in a state of calamity…in a state of panic” and needed to come up with a prompt response.
Sen. Joel Villanueva also took issue with PhilHealth’s favoring some clinics and not releasing sufficient funds to Covid-19 hospitals under its IRM program.
Villanueva said PhilHealth should have ensured the hospitals treating Covid-19 patients were prioritized in the grant of IRM, instead of allowing other medical facilities to utilize the same program for their claims.
“The numbers would speak for themselves: All freestanding dialysis clinics got releases of 100 percent of their IRM limit, while many hospitals only got 60 percent to 70 percent of their limits.”
Whistleblowers
More alleged fraudulent schemes in PhilHealth were unveiled at the hearing by whistleblowers.
Resigned PhilHealth anti-fraud legal officer Atty. Thorsson Montes Keith disclosed an alleged attempt in May 2019 to “embezzle” P9.7 million in PhilHealth benefit claims, said to be “inadvertently credited” by PhilHealth Region 2 office personnel to Balanga Rural Bank, which is located in Region 3.
Keith said he doubted the claim that the amount was mistakenly credited to Balanga Rural Bank because the money was credited in multiple transactions.
Moreover, he said he learned that it is impossible for one PhilHealth regional office to deposit money to an account in another region except when it is “given” by Senior Vice President and Chief Information Officer Jovita Aragona.
He added the Balanga Rural Bank did not want to return the money at first, but later relented after getting a demand letter from PhilHealth. Still, the bank demanded compensation for all the inconvenience it suffered by the error, with PhilHealth paying the equivalent one half of 1 percent of the amount being claimed or P49,193.
This amount, Keith believed, was not paid by the personnel from the PhilHealth Region 2 but by the PhilHealth central office. “The question that should shed light in this investigation is who owns the account in Balanga Rural Bank and what is the account number?”
He said he gathered that Senior Vice President Rodolfo del Rosario Jr. had travelled frequently to Balanga so he said it is “possible” that the money was transferred to his account.
Del Rosario, he said, was supposed to investigate these kinds of fraud but he allegedly “sat down” on it.
“Be that as it may, the only thing to do is to determine the real owner of the account in Balanga, Bataan, and it will open a pandora’s box. Further this case has established one of the modus operandi of PhilHealth mafia untouchables and I have identified some of them,” Keith added.
Responding to the allegation, Aragona maintained that there was an error in selecting the bank that will receive the money.
For his part, Del Rosario insisted that he is not involved in any corrupt practices, adding that the allegations of Keith were “ridiculous.”
He denied sitting on the case, saying an ad hoc committee was formed to hear the case.
He described his trips to Bataan as work-related meetings.
Samuel P. Medenilla, Butch Fernandez, Bernadette D. Nicolas