The amount of Philippine Health Insurance Corporation’s COVID-19 reimbursement to the Davao City-based Southern Philippines Medical Center was big because it is a big hospital, Health Undersecretary Maria Rosario Vergeire said Wednesday.
She made her statement after PhilHealth's legal counsel, Roberto Labe Jr., said during Tuesday’s Senate inquiry on the alleged corrupt practices in PhilHealth that SPMC had the highest amount of IRM or Interim Reimbursement Mechanism allocation of P326 million.
Several private hospitals, meanwhile, have yet to receive reimbursements from PhilHealth for treating COVID-19 patients.
The investigations on the allegations of corruption in PhilHealth, with resigned officials at the state insurer alleging systemic fraud—including overpriced procurements, selective reimbursements to hospitals and overpayments to other medical facilities, among others—are now being conducted by the Senate and the House, as well as by an inter-agency task force.
“There are still many who are yet to receive reimbursements. That's what we're wondering about because, as of the last time we made a list, around 120-plus members have yet to get reimbursements but there was a release on July 31,” said Private Hospitals Association of the Philippines Inc. Executive Director Jose Rene De Grano.
As state health insurer, PhilHealth, to which Filipinos pay a monthly premium, covers to a certain degree the medical treatment of its members.
De Grano said his group also wondered why the end-of-July release from PhilHealth's internal reimbursement mechanism included many dialysis centers.
SPMC eclipsed UP-Philippine General Hospital in Manila—a COVID-19 referral facility—which was allotted only P263 million worth of IRM.
“Itong IRM, how they compute it is based on historical claims, iyong claims for three months the previous year. Wala pa tayong COVID noon,” Vergeire said.
“SPMC is a 1,200-bed hospital. Comparing it with other hospitals, ito na ang pinakamalaking hospital na meron tayo and they take a lot of cases, even specialized cases. Kaya hindi rin tama na ma-ico-compare natin ito sa mga regions with [a lot of] COVID-19 cases,” Vergeire said.
Vergeire says SPMC is capable of treating hard specialty cases and various types of cancer, and is equipped with high-technology facilities.
“Kaya kung saka-sakaling mataas, marahil iyon ang kadahilanan, iyong kalakihan ng kanilang ospital,” Vergeire said.
During the same Senate hearing, however, Senator Joel Villanueva also called out PhilHealth for releasing 100 percent of the IRM allocation of dialysis clinics when only 50 percent to 70 percent of the IRM entitlement of other COVID-19 hospitals amid the COVID-19 pandemic were released.
Based on Health department records, the most number of COVID-19 cases is with the National Capital Region with 76,870.
Region 4A or Calabarzon ranked second with 18,054.
Rounding up the top five were Region 7 or Central Visayas with 17,784, Region 3 or Central Luzon with 4,166, and Region 6 or Western Visayas with 2,317.
Davao City, the hometown of President Rodrigo Duterte, is in Region 11 or Davao. His daughter Sara Duterte is mayor of Davao City.
Also on Wednesday, Senate Majority Leader Juan Miguel Zubiri said it was unlikely that Duterte had a hand on why SPMC received the lion's share of PhilHealth's releases under the IRM.
“I don't think the President had asked them to put the money in Davao, those Davao City hospitals. I don't think he’ll do that,” Zubiri told ANC.
“Baka mayroong nagsisipsip lang kay Pangulo, maybe that’s one.”