STATE auditors have questioned payments totaling P782.282 million made by the Philippine Health Insurance Corporation (PhilHealth) to a contractor for improperly documented Reverse Transcription- Polymerase Chain Reaction (RT-PCR) tests during a 21-month period from January 2020 to September 2021.
The Commission on Audit said the payment covered 265,490 RT-PCR tests which have been referred to the Fraud Audit Office (FAO) for “a more in-depth investigation.” It added that the special audit team will come out with a separate report on the said transactions.
Auditors noted that under the Memorandum of Agreement (MOA) between PhilHealth and the contractor, a P100 million cash advance was released as initial funding subject to replenishment upon submission of required documents.
The MOA provided that no additional funding will be released pending the submission of fully accomplished case investigation forms (CIF) duly signed by the person tested and a summary of test results certified by the contractor’s pathologist submitted to the Department of Health (DOH) and the Research Institute for Tropical Medicine (RITM).
However, post audit of 69 disbursement vouchers pertaining to payments released by PhilHealth amounting to P782.282 million showed 265,490 claims were not backed by duly accomplished CIFs nor signed by the persons tested.
“Review of the sampled CIFs showed 100 percent remain either partially or not fully filled out. in the absence of the duly accomplished CIFs, the Audit Team has no point of reference to verify the consistency of data provided in the CIF and line list,” the audit team said.
The COA noted that because of the urgency of the tests, the processes were already relaxed by simplifying the documentary requirements to prevent a bottleneck on RT-PCR tests due to delayed funding.
However, due to the non-compliance of the simplified process, auditors said they were precluded from determining if the tested individuals were properly evaluated; if the tests were actually administered; if the persons who underwent testing were eligible in accordance with the prioritization scheme of the DOH; and if these persons consented to the tests.
“It appears that both parties have fallen short in fulfilling their obligations over these claims as the Contractor submitted improperly accomplished and unsigned CIFs, which PhilHealth willingly accepted despite their impropriety,” the COA noted.
Responding to the audit observation, the PhilHealth management said it has already notified the contractor through a letter dated May 23, 2022 to submit properly filled-out CIFs in support of the claims and assured the COA that the documents would be submitted to it once obtained.