PhilHealth’s ills: corruption and more

posted November 06, 2020 at 12:20 am
by  Jenny Ortuoste
"We should also look into the way PhilHealth conducts business and delivers its services."

Conclusion

Given President Rodrigo Duterte’s most recent directive to rid government of corrupt officials and employees by the end of his term, we can expect the investigative and justice agencies to be working even harder to clean up the Augean stables that is the Philippine Health Insurance Corp. (PhilHealth).

Days prior to the President’s announcement on Nov. 2, the National Bureau of Investigation filed graft complaints against eight PhilHealth officials and four private hospital officers in Cebu City for approving the allegedly fraudulent claim for a non-COVID-19 patient, even as other benefit claims for COVID-19 cases in the region are also being scrutinized.

NBI acting director for Central Visayas Rennan Augustus Oliva said the probe is based “on the President’s order to the DOJ (Department of Justice) to create a task force to investigate PhilHealth irregularities and anomalies.”

The proper government agency – the Civil Service Commission? the Department of Budget and Management? – should also look into the way PhilHealth conducts business and delivers its services, and determine who is responsible for the mismanagement in the agency that resulted in the payment arrears to the Philippine Red Cross for its COVID-19 testing service.

From a gargantuan P1.1 billion, PhilHealth has whittled down its debt to the Red Cross to P477 million, but only after the humanitarian organization put its foot down and halted testing until some payment was made.

PhilHealth gave a partial payment of P500 million on Oct. 27, leading Red Cross chief Senator Richard Gordon to allow the resumption of testing that night. PhilHealth paid another P100 million a few days later, but incurred another P16 million in debt due to additional services rendered by the Red Cross.

“[But] PhilHealth is prepared for that,” Gordon said. “They have the money. I know they have the money.” Asked about a deadline for payment, Gordon said there was none, but added, “It’s a deadline based on their conscience.”

Ponzi scheme?

What galls is that PhilHealth should not have failed to pay Red Cross on time, as it rakes in immense sums from the nation’s employees through forced contributions. One lawyer has likened this system to a “Ponzi scheme.”

Lawyer Saul Hofileña Jr., who taught insurance law and criminal law at San Beda College, explained:

“PhilHealth administers our country’s health insurance program.  It was primarily created to help the poor and the downtrodden, to provide them with medical care.  The law states that all Filipinos must contribute to Philhealth, even foreign nationals working in this country.

“Its method of collecting money, what is referred to as ‘contributions,’ which word strengthens the belief that money collected is a form of tribute and therefore non-refundable, is systematic. Premiums are automatically deducted by employers from the salaries of employees.

“When a person pays PhilHealth, although involuntarily, PhilHealth is obligated, since it has entered into a contract of insurance, to defray, either partially or entirely, the medical expenses of the insured individual at a time when he needs it most, i.e., when he is incapacitated by illness.

“Because PhilHealth benefits will only be paid, not on demand, but primarily when the person who made the contributions needs it, the fund becomes a tempting playground for Ponzi scammers, referring to a type of investment fraud wherein funds collected from new contributors are used to pay old ones, dissipating  old  funds to line the pockets of the unscrupulous.”

CPA as investigator

 Hofilena said Dante Gierran’s appointment as PhilHealth president is “apropos” because as a CPA-lawyer and a former NBI official who rose from the ranks, he can “find evidence to nail down those responsible for defrauding the agency without resorting to subpoena which oftentimes is resisted in court by those to whom it is directed.”

In this situation, a doctor or healthcare expert is not what is needed.

Hofilena added that a CPA makes a good investigator because “crimes of this character leave a paperwork trail that may appear fair and regular to the average person, but are really important pieces of documentary evidence to those whose eyes have been trained and honed by experience in tracking down white-collar criminals.”

Plunder?

In addition to the PhilHealth officials recently charged in the Visayas, other agency officials have had cases filed against them before the Ombudsman for violating the Anti-Graft and Corrupt Practices Act and the Revised Penal Code, and other charges.

“The investigative agencies should also look into the possibility of filing plunder charges, after a thorough examination of the documents on file with the Commission on Audit or the PhilHealth,” Hofileña said.

He explained, “Under the law on plunder, if it is found that a public official has amassed ill-gotten wealth through a combination or series of overt or criminal acts in the aggregate sum of P50 million, he may be charged under the law which is a non-bailable offense.  Any person who participated in the commission of plunder, even if he is a private individual, will likewise be charged with the crime.

“The crime of plunder is easier to establish since it is not necessary to prove each and every criminal act done by the accused in furtherance of the scheme or conspiracy, or accumulate ill-gotten wealth, it being sufficient to prove beyond reasonable doubt a pattern of overt or criminal acts indicative of the overall scheme to steal money from the government,” Hofileña said.

“Conviction of the crime of plunder carries with it the applicable penalty of reclusion perpetua and the State is not barred by the lapse of time from recovering properties unlawfully acquired by the public officer convicted of plunder either from the public officer himself or from any of his nominees or transferees,” he added.

Surface the missing Philhealth billions now! FB and Twitter: @DrJennyO

Topics: Rodrigo Duterte , Philippine Health Insurance Corp , COVID-19 , Ponzi scheme , Red Cross , Richard Gordon , National Bureau of Investigation
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