A lawmaker has revealed a new anomaly with the Philippine Health Insurance Corp. (PhilHealth), this time involving the reimbursement of COVID-19 swab tests already paid for personally by its members.
In a privilege speech late Tuesday, Deputy Majority Leader Bernadette Herrera said a forensic audit would be needed to uncover the extent of a new modus operandi that potentially involves P29.77 billion that PhilHealth has earmarked for 10.12 million COVID-19 swab tests.
“I have received numerous reports about this systematic anomaly whereby PhilHealth members who have not availed of the COVID-19 testing benefit package are asked to provide their PhilHealth identification number,” the lawmaker represents the party-list group Bagong Henerasyon said.
“Once provided, a hospital or testing center then processes a reimbursement against that person’s PhilHealth account, and the money is pocketed by these unscrupulous individuals,” she continued.
Herrera said no less than her brother, Quezon City Councilor Bernard Herrera, almost fell victim to the new scheme.
She said the councilor received a text message from the billing department of the Pampanga hospital which processed his COVID-19 polymerase chain reaction (PCR) test, asking for his PhilHealth account number.
The councilor refused to give his account number, believing there was no need for the hospital to process the reimbursement since he personally paid for his swab test and that he did not avail of PhilHealth’s testing benefit package at all.
“This is one hospital, out of so many that are capable of doing this. The magnitude of this anomalous scheme is beyond comprehension. This is so systemic, so complicated, that it cannot have been done without complicit actions of people within PhilHealth,” Herrera pointed out.
PhilHealth has set the rate of its COVID-19 testing package at P3,409 if all services for testing will be procured and provided by the testing laboratory, Herrera noted.
This can be priced lower to P2,077 if the test kits that will be used are donated to the laboratory, and as low as P901 if the test kits are donated and the PCR (polymerase chair reaction) machine used for swab tests is in the budget of the testing facility. With Macon Ramos-Araneta
Citing PhilHealth’s own records, Herrera said the state health insurer has a budget between P27.88 billion and P29.77 billion for 10.12 million COVID-19 tests.
However, the legislator lamented that only 2.39 percent of the total number of tests have been done and 9.6 percent has been spent by PhilHealth out of its total budget for test claims.
As of last August 17, a total of 105 testing centers are accredited under this system, with 42 in the National Capital Region alone, she noted In its report dated September 4, PhilHealth said that only 11,416 claims were paid prior to June 25 and a dismal 1,152 claims were paid after that same date.
“Are we now to believe that a total of 12,571 tests were paid for? That only 72,189,498 pesos were actually paid out thus far?” Herrera asked.
The party-list lawmaker then called for an immediate investigation and termination of such illicit activity perpetrated by private hospitals and testing centers and the “good-for-nothings within PhilHealth.”
Herrera denounced those involved in what she called “syndicated corruption” for “exploiting the emergency of the pandemic to steal from the health fund.”
Meanwhile, Chief Presidential Legal Counsel Salvador Panelo on Wednesday said President Rodrigo Duterte has to be presented with enough evidence of corruption to fire Health Secretary Francisco Duque III and other PhilHealth officials.
In an interview over PTV-4, Panelo said the Task Force PhilHealth is being careful when it comes to investigating alleged corruption within the state insurer.
“It should be backed by documents, paper trail. Because if you say they’re involved, they released this much, if they’re all talk, no documents, no papers, then it will be dismissed by the court,” he said.
On Monday, Justice Secretary Menardo Guevarra said the task force is set to release its report on the probe into alleged anomalies hounding the state firm including possible administrative and criminal charges against erring officials by Sept. 14.
Also, Senator Christopher “Bong” Go told Philhealth officials to ensure continued public service delivery and work towards the full implementation of the Universal Health Care, despite the controversies plaguing the agency.
“While we intensify our efforts to remove systemic corruption and prosecute those involved in anomalies to the fullest extent of the law, we still expect the agency to fulfill its mandate and provide the people the fullest extent of services they deserve,” Go said.
He emphasized that now, “more than ever, the country needs a working PhilHealth that is free from corruption under its new leadership, to provide Filipinos continued and better access to quality healthcare.”
“Even an ordinary Filipino is interested to know the truth especially during this time when they need to run to PhilHealth for help. We don’t want that time when patients will be rejected by a hospital because he has no money,” said Go. With Macon Ramos-Araneta