PhilHealth OK’d P600M payment hospitals with rejected claims

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    SURIGAO del Norte Rep. Robert Ace Barbers yesterday questioned the Philippine Health Insurance Corporation’s (PhilHealth) approval of more than P600 million in late payments to hospitals with rejected claims.

    Barbers said the board on May 14 approved the claims even if these have been ejected by PhilHealth’s Protest Appeals and Review Department (PARD) between 2011 to 2019.

    “In an unexplainable sudden turn of events last May 2020, without the required detailed evaluation of each claim, PARD reversed its decisions and decided to grant its version of an ‘amnesty’ by paying all these hospitals,” he said in a statement.

    Out of the total of more than P4 billion in claims, the board only allowed a little over P600 million to be paid to hospitals.

    “How can the PARD and former SVP Del Rosario justify this very anomalous deal? PARD is under the office of SVP Jojo del Rosario. With the lame excuse of helping these hospitals cope with the COVID pandemic, they suddenly became generous and considerate after years of neglecting these claims,” Barbers said.

    He was referring to former PhilHealth senior vice president for legal sector Rodolfo del Rosario Jr. who recently resigned amid the investigations into the alleged massive corruption in the agency.

    Barbers said that while the claims should have undergone detailed scrutiny and evaluation before being reconsidered, he was wondering how the officials would evaluate claims from two to nine years ago.

    If the reason for reviving the claims because PhilHealth committed mistakes, he said the officials involved are liable for gross negligence and gross neglect of duty under the Anti-Graft and Corrupt Practices Act “for sitting on these transactions all these years.”

    “The board did not even do a simple due diligence and blindly approved the recommendations for ‘amnesty’ of PARD and SVP del Rosario. They are all grossly negligent and entered into a deal that is grossly disadvantageous to the government,” Barbers said.

    The joint committee on public accounts and on good government have instructed PhilHealth to submit to the committee all pertinent documents on the P600 million claims as it prepares a committee report of its findings and recommendations for the filing of graft and plunder charges against some officials and their cohorts in private hospitals.

    On Wednesday, Health Secretary Duque decried the recommendation of the Senate committee of the whole for criminal be filed against him over the agency’s interim reimbursement mechanism (IRM) which was found to be a source of graft and corruption in the agency.

    Duque said he is being impleaded when he did not even participate in the deliberation and did not sign any document on the IRM.

    “Why are they pinning me when the rest who participated in the deliberation and signed the IRM resolution were not included? Is the Senate so intent in removing me that they invent a finding that is not supported by official documents?” he said.

    While it is not easy for him to attend to the various concerns of the Department of Health, the inter-agency task force (IATF) on emerging infectious diseases and PhilHealth, Duque said he still cooperated with the Senate and the House “in ascertaining the truth.”

    APPEAL

    Two senior PhilHealth officials who were ordered placed under six-month preventive suspension on August 18 have asked the Office of the Ombudsman to recall the order.

    PhilHealth senior vice president Dennis Mas and PhilHealth NCR Legal Services head Lawrence Mijares lamented the timing of their suspension, saying it was premature and only served to divert the public’s attention from the PhilHealth officials who are accused in a Senate investigation of operating like mafia.

    They clarified that the case against them has nothing to do with the ongoing congressional inquiry involving alleged illegal release of IRM funds and the computerization project of PhilHealth.

    The respondents said the complainants against them are the same people now being accused in the Senate of mafia-like activities but who are now being portrayed as “victims-complainants and therefore could not be villains anymore.”

    “The complainants, an apparently strong and organized group, are now portrayed as victims. Senator Richard Gordon, chairman of the Senate Blue Ribbon Committee, branded this group as the real mafia but now they are given special treatment as complainant-victims,” they said.

    They likewise raised procedural challenges to the suspension order, claiming they were not accorded the chance to answer the allegations leveled against them.

    The Ombudsman said the charges against the PhilHealth officials “involve grave misconduct, oppression and conduct prejudicial to the best interest of the service which may warrant removal from the service.”

    However, Mas and Mijares the complaints were merely retaliatory for their involvement in the “filing and prosecution of the complainants in several (administrative) cases” based on the orders their superiors.

    “All the actions of herein respondents in the performance of their duties are presumed regular and above board. The ultimate decision to file, prosecute, and impose sanctions were never within the power of herein respondents in their individual capacities,” they said. — With Peter Tabingo