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PhilHealth ‘inaction’ on fraud draws solon’s ire

House Deputy Speaker Jesus Crispin Remulla stormed out of a hearing Friday, saying he would sue the Philippine Health Insurance Corp. (PhilHealth) over its inaction on fraudulent reimbursements to hospitals.

“I’m not satisfied with the answers. I’ll just see them in court,” Remulla said, cutting off Health Secretary Francisco Duque III, who was saying that in some far-flung areas, patients had made a collective appeal that erring hospitals be fined instead of being suspended.

Duque was responding to Remulla’s question about whether PhilHealth was letting hospitals get away with fraud.

Meanwhile, Senator Leila de Lima said alleged irregularities in the multi-million-peso agreement between PhilHealth and the Philippine Red Cross (PRC), headed by Senator Richard Gordon, should be investigated.

“We should investigate whether the questionable provisions in this MOA are repeated in other agreements entered into by PhilHealth. Even as many hospitals feel the pinch of having to wait for PhilHealth reimbursements for their COVID-19-related expenses, we see some institutions favored by not just prompt but advanced payments agreed to in spite of clear statutory prohibitions,” De Lima said.

She noted that the allegations against Gordon, the PRC chairman, are serious enough to warrant a separate full-blown investigation on the precise nature of the transaction between PRC and PhilHealth.

“Gordon should answer the allegations of impropriety against him in his capacity as Philippine Red Cross (PRC) chair, as senator and chair of the Blue Ribbon Committee,” she added.

Some irregularities were undeniable, De Lima said.

She said Gordon, in his capacity as Blue Ribbon Committee chairman, was still investigating PhilHealth when the memorandum of agreement (MOA) between PRC and PhilHealth was negotiated and signed. She said Gordon himself signed the MOA.

“That is a clear conflict of interest,” she said.

Also De Lima noted that PhilHealth, as a government-owned and controlled corporation, could not agree to advance payments as it is contrary to the law.

“Yet, it was included in the MOA. In fact, P100 million was paid upfront upon execution of the MOA,” she said.

She said the Bayanihan to Heal as One Act did not repeal or suspend the provisions of the State Auditing Code, which prohibits payment of advances without prior approval of the President.

“It cannot be argued that the basis for the advance payment agreement is the interim reimbursement mechanism (IRM). Under PhilHealth Circular 2020-0007, the IRM is limited to Health Care Institutions (HCIs) directly hit by fortuitous events with clear and apparent intent to continuously operate and/or rebuild. The PRC does not fall under this qualification. Former PhilHealth executive Rodolfo del Rosario, Jr. also admitted that the MOA with the PRC is not covered by the IRM,” De Lima said.

The apparent intent, she said, is for the MOA to be an agreement different from the IRM agreements under PhilHealth Circular 2020-0007.

“What then is the statutory basis for agreeing to advance payments?” De Lima asked.

Furthermore, she said Gordon’s report suspiciously left out the national leadership of PhilHealth, led by its former president and CEO Ricardo Morales.

“These PhilHealth officials are the very same officials with whom the PRC negotiated the MOA. Mr. Morales and his fellow officers are now facing administrative and criminal charges recommended by Task Force PhilHealth and approved by no less than President Duterte.”

De Lima said the administration’s actions on these allegations will reflect its commitment to the rule of law.

PhilHealth spokesman Rey Baleña on Friday said millions of Filipino s will bear the brunt if the state health insurer would be abolished amid the COVID-19 pandemic.

President Rodrigo Duterte was quoted as saying he wanted to abolish or privatize PhilHealth, which has been racked by corruption scandals.

But Senate President Vicente Sotto III said he advised the President to wait a few months to see how well the newly appointed president, Dante Gierran, performs.

Last month, whistleblowers claimed that the so-called PhilHealth mafia, allegedly composed of the executive committee, was able to pocket P15 billion worth of funds from the state insurer—an allegation denied by the agency.

A Justice Department-led task force recommended that charges be filed against seven top PhilHealth officials, including Morales.

Gierran, a former director at the National Bureau of Investigation, was given until December to “clean up the organization” but the Palace clarified it does not mean his term will end soon.

Baleña said Gierran has the full support of the PhilHealth workforce.

PhilHealth was created in 1995 to implement universal health coverage in the country. As a government-owned and controlled corporation, PhilHealth is tax-exempt and attached to the Department of Health.

Under the Universal Health Care Act of 2018, all Filipino citizens must be automatically included in the National Health Insurance Program either as direct or indirect contributors. 

Topics: PhilHealth , Jesus Crispin Remulla , COVID-19 , Department of Health
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