President Rodrigo Duterte on Monday asked the acting chief and board of directors of the Philippine Health Insurance Corp. to submit their courtesy resignations after reports showed the state-run health insurance company paid out billions of pesos for bogus dialysis treatments performed on non-existent or dead patients.
The announcement was made by former Duterte aide Christopher Go, who has won election as a senator. He said he would ask the President to start a revamp of the PhilHealth.
Presidential Spokesman Salvador Panelo said the President was set to meet Philhealth officials in Malacañang later.
Earlier, President Duterte ordered the National Bureau of Investigation to conduct a probe on PhilHealth and file criminal complaints against any officials involved in corruption.
“All persons involved in the alleged fraud will be prosecuted and face accountability. They shall reap the harshest penalty imposed by law. Nothing can shield them from prosecution and punishment,” he said.
Allegations of corruption in PhilHealth surfaced after a former employee of WellMed Dialysis Center, a dialysis center in Quezon City came forward to reveal a “ghost dialysis” scheme used to make fraudulent claims to the government health insurance firm.
“We will put a stop to this corruption and we will make sure that the law on universal health care is strictly enforced,” Panelo said.
PhilHealth said it was investigating 2,000 health providers on possible fraudulent claims.
Meanwhile, Health Secretary Francisco Duque III yesterday said he wants the PhilHealth to release to the public the names of health care providers facing investigation.
Duque said PhilHealth may release the names “without rendering any judgment.” He said this is a factual narrative or a factual listing of health care providers with pending cases.
Amid reports of alleged irregularities involving bogus kidney treatments allegedly paid for by PhilHealth, the state insurance company bared last week that it is probing over 8,000 cases of fraudulent acts, among these 78 hospitals and at least 18 doctors.
The health chief said the Department of Health is aiming to emulate the Bureau of Internal Revenue, which publicizes corporations facing tax cases before the Department of Justice..”
PhilHealth earlier disclosed that they were able to monitor fraudulent acts involving WellMed. Their findings showed that 28 of the medical cases that have been filed involved dead patients while 12 others are under investigation.
At the same time, Dr. Roy B. Ferrer, PhilHealth acting president, and CEO denied the P154 billion overpayments allegedly made in its claims in the past six years, stressing that they are “efficiency gains,” a feature in the case rates payment system that the agency is implementing.
It also allows PhilHealth to effectively impose the No Balance Billing (NBB) policy for sponsored program members admitted in a ward or ward-type accommodations in government health care institutions.
The state agency is currently paying its health care providers using case rates, a fixed amount that covers both hospital and professional charges.
The report has alleged that PhilHealth’s increasing payments for pneumonia from 2010 to 2018 have reached “epidemic proportions” when there was no outbreak of pneumonia declared by the Department of Health.
PhilHealth pointed out that data reports of DOH are figures based on public health units and facilities, while PhilHealth’s claims statistics are based on actual payments of claims made to its health care providers. So both figures cannot be compared.
In the particular case of pneumonia, figures are based on those that have actually sought treatment for the ailment in both private and government hospitals nationwide.
Meanwhile, the owner of Wellmed, Brian Sy, told the NBI that former employees of the clinic were the ones supposedly involved in fraudulent claims.
Under the scheme, the clinic receives payments from PhilHealth for dialysis treatments even though some of the patients have long been dead.
