THE Commission on Audit has expressed alarm after discovering that over 1.6 million enrolled senior citizens in the database of the Philippine Health Insurance Corp (PhilHealth) have problematic data entry, including more than a quarter million who were listed twice and over 4,000 who have passed away but are still in the list as of yearend 2023.
State auditors said the 266,665 double or multiple entries are equivalent to at least P1.333 billion in government subsidy that the national government had to pay to PhilHealth as senior citizens are exempt from paying contributions under the law.
The bigger cause for concern, however, is the 1,335,274 senior citizen beneficiaries whose data were found to be either incomplete or erroneous which increases the risk of duplicate or multiple enrollments in the PhilHealth Members Information System.
The bigger cause for concern, however, is on the 1,335,274 senior citizen beneficiaries whose data were found to be either incomplete or erroneous, which increases the risk of duplicate or multiple enrollments in the PhilHealth Members Information System.
A separate verification with 250 hospitals and clinics conducted by the audit team uncovered thousands of senior beneficiaries who have passed away between 2019 to 2022 but remained on the PhilHealth Membership Database (PMD), hence billed to the Department of Budget and Management (DBM) as of 2023.
In all instances where more than one entry is made for a senior member or when a dead beneficiary is not removed from the system, PhilHealth collects more money from the government in the form of subsidy.
Worse, the audit team warned that such inaccuracies render the PMD unreliable as a basis for policies and projections – and vulnerable to possible fraudulent claims.
ERRONEOUS/INCOMPLETE
COA noted that there are 8.586 million senior citizens enrolled with PhilHealth so that the 1.33 million seniors with data entry errors comprise over 15 percent.
Based on the total number of seniors in 2023, the national government released P42.93 billion in subsidies through the DBM at P5,000 per head. This means P6.44 billion of the subsidy was for the 1.33 million elderly with questionable data entries.
The standard operating procedure for member enrollment was to fill in five data fields – last name, first name, middle name, birthdate, and gender – before assigning a personal identification number (PIN). But based on validation made by the audit team, encoders entered only the middle initial instead of the full middle name in 1,254,136 entries.
In another batch of 70,931 entries, no middle name, not even a middle initial was entered, in addition to 328 with misspellings and five with no first or last names.
“The enrollment of members without middle names, with middle initials only, with last names consisting of only one letter, and with other irregularities and errors increases the risk of double or multiple entries per member since the matching validation is programmed to detect only an absolute match,” the COA said.
Auditors recommended that PhilHealth direct all provincial and regional offices to make validations and corrections on the problematic entries and to impose sanctions on encoders if the mistake is traced to their actions.
The PhilHealth said it is already conducting a monthly clean-up of its database for inaccuracies.
At the same time, encoders are given annual re-orientation or refresher trainings to minimize data entry mistakes.
266,665 DOUBLE ENTRIES
In 2020, state auditors already flagged the PhilHealth for double or multiple entries of the same member on its database. Three years later, verification by the audit team revealed the problem has not been addressed with 266,665 senior citizen accounts found to contain the same first and last names and birthdays.
“The submitted data on enrolled beneficiaries revealed duplicate or multiple entries in the last and first name, and birthdate of 266,665 enrolled SC (senior citizen) members equating to a subsidy from NG (national government) of P1.333 billion,” the COA said adding such multiple entries cause overstatement of billing charged to the government while misleading the public as to the actual number of beneficiaries covered in the National Health Insurance Program (NHIP) and the measurement of PhilHealth’s performance and accomplishment.
In response to the findings, the PhilHealth said it will no longer include the similar sounding names in the billing to the DBM but will be addressed to the provincial and regional units for correction.
DEAD BUT ACTIVE?
From the list of seniors billed to the DBM for subsidies, the audit team sent letters to 250 healthcare institutions requesting for the list of deceased patients as of Dec. 1, 2022.
Of the said number, only 63 hospitals and clinics (HCLs) answered but even that limited data showed thousands of senior members who passed between 2019 to 2022 were still listed on the PhilHealth membership database.
Auditors said the number could be a lot higher.
“It is emphasized that the 63 respondents (HCLs) represent only 3.41 percent of PhilHealth’s total 1,846 accredited hospitals as at July 31, 2023 as indicated in the PhilHealth website, not to mention those (enrolled senior citizen) who died outside hospitals,” they pointed out.
Since the verification was based on the list submitted to the DBM, the audit team said it means all the 4,062 dead seniors were still “active” on PhilHealth’s system.
The PhilHealth management said it has entered into a data-sharing agreement with the Philippine Statistics Authority on death information data in 2021, and the agreement has resulted in the exclusion of 661,533 dead members out of 5.42 million members.
PhilHealth said it expects to complete the updating of the database by July 2024.
Still, it requested the COA for its list of deceased senior citizen members so it can do its own validation.
