Ombudsman suspends 8 PhilHealth execs over P2.7B fund releases

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    THE Office of the Ombudsman has suspended eight top officials of the Philippine Health Insurance Corporation (PhilHealth), led by chief operating officer Arnel F. de Jesus, who are facing investigation for alleged criminal and administrative offenses in connection with the disbursement of P2.709 billion from the interim reimbursement mechanism (IRM) program to various hospitals and healthcare institutions in Metro Manila.

    In a seven-page consolidated order signed late yesterday, Ombudsman Samuel Martires directed PhilHealth president and CEO Dante Gierran to enforce the six-month suspension against De Jesus; Rene Limsiaco, executive vice president; Israel Francis Pargas, senior vice president; Gregorio Rulloda, PhilHealth-NCR vice president; Imelda Trinidad de Vera-Pe, head of the Benefits Administrative section; Lolita Tuliao, NCR-branch manager; Gemma Sibucao, fiscal examiner; and Lailani Padua, fiscal controller.

    The Ombudsman said the order “is immediately executory and shall not be interrupted within the period prescribed notwithstanding any motion, appeal, or petition that may be filed by respondents seeking relief… unless otherwise ordered by this Office or by any court of competent jurisdiction.”

    The suspension order was based on a complaint filed by the National Bureau of Investigation-NCR on October 2, citing irregularities in the issuance of cash advances to 139 healthcare institutions (HCIs) in Metro Manila.

    It said the fund releases were in the form of cash advances, which was contrary to procedural guidelines of the Commission on Audit and were made even prior to the effectivity of PhilHealth Circular No. 2020-007 (Guidelines on the Provisions of Special Privileges to those Affected by a Fortuitous Event) dated June 11, 2020.

    The NBI-NCR stressed that the release of IRM Funds was not covered by Presidential Proclamation No. 929 s. 2020 that declared a state of calamity over the whole country due to the COVID-19 pandemic.

    It noted that the respondent PhilHealth officials participated in the process that allowed prepayments to hospitals under so-called “fortuitous event” which include the pandemic.

    Likewise, the NBI accused the PhilHealth officials of negligence in according favors to the 139 HCIs by approving their inclusion in the release of IRM funds without first checking their track records in rendering healthcare services.

    It added that among the recipients were found to be dialysis centers, maternity clinics, and infirmaries that did not admit or offer treatment to COVID-19 patients.

    The Ombudsman said the imposition of suspension is warranted because all the elements required are present: the offense involves dishonesty, oppression or grave misconduct; the charge would warrant removal from service; and the respondents’ continued stay in office may prejudice the case.

    “Respondent facilitated these anomalies by affixing their signatures on official documents causing the release of the questioned IRM funds. After a thorough consideration of the records, this Office finds sufficient cause to place respondents under preventive suspension,” the Ombudsman said.

    Sen. Richard Gordon, chairman of the Philippine Red Cross, demanded that PhilHealth pay in three days the P561-million it still owes the humanitarian organization.

    PhilHealth paid the PRC P500 million on Tuesday, which represents at least 50 percent of the P1.06-billion it owes PRC.

    Right after PhilHealth paid P500 million, Gordon said the PRC resumed accepting referrals from the state insurer, including arriving Filipino workers. He said testing of molecular labs in other areas resumed yesterday morning.

    Gordon said the remaining P561 million represents 169,475 COVID-19 tests done in past months.

    “The debt is due and demandable. The agreement says upon demand by the Red Cross of payment when we submit the receipts and all the things that go with this such as the records, pictures, and results. They should pay in three days… They should do that. We’re not even charging interests,” Gordon told ANC’s Headstart program.

    In a letter to the PRC on Tuesday afternoon, PhilHealth president and chief executive officer Dante Gierran assured PRC the state insurer will pay the balance of P561 million as soon as “the documentary requirements for claims are validated and verified by PhilHealth.”

    Gierran also said that PhilHealth “would like to propose the renegotiation of the terms of the subject MOA (memorandum of agreement).”

    Gordon said that as far as the PRC is concerned, it has submitted all required documents.

    He also said he does not know what needs to be renegotiated in the PRC’s contract with PhilHealth.

    He reiterated the PRC needs funds to operate as its supply of test kits is fast being depleted. He said the PRC processes around 11,000 specimens a day. — With Raymond Africa