PhilHealth on the hunt for hospitals involved in fraud

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    THE Philippine Health Insurance Corporation (PhilHealth) yesterday it is in the process of identifying individuals and institutions involved in corrupt and fraudulent practices that have led to billions in losses in the state agency’s funds.

    In a briefing, PhilHealth vice president Oscar Abadu Jr. said newly-installed president and chief executive officer Dante Gierran has ordered the “profiling” of healthcare providers that have been tagged for fraudulent acts.

    He said the profiling is meant to determine “whether there are red flags in these providers, and try to address if there are individuals, doctors, or healthcare institutions committing acts of fraud.”

    He said the profiling is part of efforts to cleanse PhilHealth of corruption and fraud.

    Earlier, Gierran ordered the mass resignation of PhilHealth officials with Salary Grade 26 positions and higher. As of last week, 27 senior officers have filed courtesy resignations and 16 have applied for retirement.

    Gierran has been given direct orders by President Duterte to do whatever is necessary to cleanse PhilHealth by December.

    Duterte has created a task force to look into the allegations of corruption in the agency.

    The task force led by Justice Secretary has recommended charges against a number of key officials, including Ricardo Morales, Gierran’s predecessor. The Senate and the House have also conducted investigations.

    Abadu said Gieran, aside from profiling PhilHealth’s partner healthcare providers, is determined to push through with the IT project of the agency despite controversies hounding it.

    “We need IT as the key to identify all acts of irregularities, where corruption happens, and possible acts of fraud will happen,” said Abadu.

    Prior to establishing the IT system, however, Abadu said Gierran wants the current PhilHealth process evaluated.

    “His plan is try to look at the processes and systems first and find out where are the possible gaps, and then later on to do the IT intervention,” he said.

    “Everything should start with the current process, the systems, and where are the gaps and loopholes that need to be addressed, so that proper IT solutions shall be provided,” added Abadu.

    Earlier, the Commission on Audit questioned supposed irregularities in the IT project of PhilHealth under Morales. In particular, COA questioned the hefty allocations for the IT project despite some items not being approved by the Department of Information and Communications Technology.