In a report published in the Manila Standard on June 27, a demand that the PhilHealth chief technical officer and chief information officer be axed was made due to alleged “apparent criminal negligence that enabled scammers to raid its coffers.”
In the same report, it was also said that PhilHealth failed “to institute appropriate software systems, business process rules, centralized patient health management records and risk management engines,” that would have prevented “ghost” kidney treatment and billings.
PhilHealth has long established data-driven reforms and innovations in preparation for Universal Health Care implementation, even prior to the WellMed issue.
Since 2012, the current Chief Information Officer has been the third CIO in PhilHealth’s history. Upon assumption to office, our current CIO and her team developed a new business-IT solution to support a fraud analytics committee created in 2018, which the CIO herself chaired.
This committee raised high levels of potential fraud (like pneumonia, sepsis, caesarean delivery, others) which are currently under investigation by the legal team. Advances in PhilHealth analytics have led to the creation of MIDAS (Machine Learning Identification, Detection, & Analysis System) which is evolving into an artificial intelligence solution. Procurement of a world-class fraud control solution was approved to strengthen MIDAS as fraud policies-requirements are defined by business teams. MIDAS is the first PhilHealth solution that has unified data from all fragmented systems, and created a single source of truth for the entire corporation including COA which is in the process of learning and auditing the system.
On an even more proactive initiative for the entire health sector, the CIO led the implementation of Electronic Claims which has started to replace all paper-based claims processes which could be a source/cause of fraud. eClaims was done even with resistance from some health care providers who preferred the status quo. Enhancement of eClaims is ongoing in a 2005-developed system which is also slated for replacement. Various transformative IT innovations have been recognized with President/CEO Excellence Awards (highest PhilHealth awards) from two different PCEOs. The IDC, a prestigious global ICT expert organization also awarded PhilHealth with transformative-leadership awards with the likes of Meralco, ABS-CBN, Unilab, and Asian Hospital among others.
These are indications that our IT team never wavered and was never negligent in implementing needed business solutions. Moreover, collaboration with central-regional business teams has been positive and productive, wherein reports of negligence as those raised in the article has never been raised. This is because IT works with business teams within PhilHealth protocols, where business policies/ processes/rules/systems to address issues as those reported in the article are defined by Business before IT solutions are enhanced or developed.
PhilHealth supports the anti-corruption goals of President Duterte, and related advocacies of groups like VACC. Transparency and objectivity will always reign in any resolution that needs to be taken for and by PhilHealth. The needs of UHC are monumental, and commensurate changes within PhilHealth including those in IT will be done with fraud control as a key goal. These will be done across the Process, People, and Technology spectrum to assure that profound PhilHealth changes will stand the test of time, politics, organizational dynamics, and UHC.
SHIRLEY“GIGI” B. DOMINGO, MD
Vice President for Corporate Affairs and Official Spokesperson
PhilHealth
