ANAKALUSUGAN party-list Rep. Mike Defensor yesterday admonished Health Secretary Francisco Duque III for ordering a review of the Philippine Health Insurance Corporation’s (PhilHealth) interim reimbursement mechanism (IRM) instead of scrapping it and all case rates system which have been exposed as the source of massive corruption in the agency.
“Instead of ordering a review, Secretary Duque should have scrapped the case rates and IRM altogether and ordered a recall of all PhilHealth funds advanced to hospitals and other recipients, and an audit of all reimbursement claims,” Defensor said in a statement.
The administration lawmaker chairs the House committee on public accounts which has been jointly conducting an inquiry into the loss of public funds in PhilHealth along with the committee on good government.
In a statement issued Wednesday night last week, Duque said confusion has arisen from the circulars issued “in the haste to readily provide the needed financial support to the Health Care Institutions (HCIs) during the pandemic.”
He said the review of the IRM would “let us look into any loopholes and clarify procedures to ensure that the issues raised are responded to.”
IRM is a system under which PhilHealth pays hospitals and other healthcare facilities in advance for the insurance claims of members, to ensure their liquidity during crises, like the COVID-19 pandemic.
Cavite Rep. Elpidio Barzaga Jr. earlier warned PhilHealth officials that there is now a clear case of malversation or illegal use of public funds against them, as they released funds through the IRM to hospitals or health facilities that do not accept coronavirus 2019 (COVID-19) cases.
It is clear in the agency’s circular that IRM is applicable only to cases involving fortuitous events such as COVID-19 but dialysis centers, private birthing facilities and hospitals not accepting COVID cases were given funds.
Defensor called for the scrapping of the IRM and the “case rates” system which has led to the loss of billions in contributions as the Commission on Audit estimates that PhilHealth has been “overpaying” health facilities by at least 20 percent through package rates.
The COA has calculated such overpayments at P154 billion over a six-year period, from 2013 to 2018.
“The (all) case or package rates system is the root of all evil and corruption in PhilHealth. IRM is its offspring,” he said.
Under the case rate system, PhilHealth pays for the entire treatment package cost that it has fixed, even if such cost is much lower than the expenses a patient-member incurs.
“For instance, they have four case rates for new coronavirus disease or COVID-related ailments. For mild pneumonia, the package costs almost P44,000. A health facility can declare its treatment for colds, cough and fever as Covid-connected mild pneumonia and get paid for P44,000 even if the actual cost is only P15,000 or P20,000,” he said.
Defensor pointed out that PhilHealth officials have admitted that even probable and suspected COVID cases could qualify for COVID packages, opening the floodgates for a “free-for-all bonanza of fraud and corruption.”
Even now, there are more COVID reimbursement claims in the Ilocos, Southern Luzon and Western Visayas regions than actual cases recorded by the Department of Health, he said.
The public accounts panel chair proposed that instead of package rates, PhilHealth should pay for the actual cost of a member’s hospitalization, treatment and medicines and just “consider the case rates as cost limits to conserve their funds.”
He expressed apprehension that a large portion of the P30 billion advanced by PhilHealth to hospitals and other health facilities under its IRM could just go down the drain through this “fraud and manipulation-prone package cost system.”
“Such system clearly breeds corruption because of collusion among hospitals, patients and corrupt PhilHealth officials and personnel,” he added.
Defensor pointed out that PhilHealth president Ricardo Morales himself has admitted such collusion in one of his committee’s hearings.
“This has been going on since 2013. The Commission on Audit (COA) has been raising red flags about possible financial losses in the billions in its annual reports. And yet, PhilHealth officials see no evil, hear no evil, speak no evil. We wonder why. They are even defending their case rates,” he said.
DOJ TASK FORCE
The Department of Justice-led task force investigating the reported PhilHealth anomalies is likely to ask for an extension of the 30-day deadline set by Malacañang for it to complete its probe and submit its findings.1
Justice Undersecretary Markk Perete said an extension would allow the task force to cover all grounds and issues in the state health insurer.
The 30 days given to the task force to complete its probe started last August 14.
“The plan is, if the task force runs out of time, we will submit an initial report by the 14th and then ask for a continuation to allow the task force to cover all grounds,” Perete said.
Perete said in the meantime, the task force is continuing its investigation while its member-agencies have already formed small investigating composite teams to look at other issues such as the information technology and legal sector of PhilHealth.
He said five witnesses — all senior officials of PhilHealth — have already appeared before the task force. Perete said they would likewise use the testimonies given during the Senate and House probes.
Perete said none of the witnesses so far have asked for special protection from the task force. — With Ashzel Hachero
