PhilHealth acting president and CEO Roy Ferrer said Sunday no mafia could survive in the state agency under President Rodrigo Duterte’s watch.
He also said the “culture of fear” in PhilHealth raised by its former official was “the PhilHealth of the past.”
He said “such fear and trembling” no longer existed in PhilHealth under President Duterte’s strong administration.
He scoffed at Minguita Padilla, who served as the head of the executive staff of a former Health secretary during the Aquino administration for her loser’s mind and defeatist attitude.
“Ms. Padilla, who served as a former Health secretary, harks back to a weak-kneed and feeble government before the robust Presidency of my boss Rody Duterte, Ferrer said.
“So when Ms Padilla spoke about the impotence and helplessness of the earlier PhilHealth leadership, she is referring to a thing of the past.”
Ferrer said the current PhilHealth board members appointed by the President would not shrink from the challenge to rid PhilHealth of shenanigans.
“Our top management executives who are directly under me are loyal to the higher ground principles and policies of PhilHealth, and no villainous mafia member can survive within their ranks, Ferrer said.
Ferrer also said the so-called “mafia members” in the countryside were actually members of a syndicate of cheating, disloyal and disgruntled PhilHealth officers who had colluded with hospitals and other health care facilities.
“This syndicate will soon disintegrate, Ferrer said.
“It is correct that these are the ones who defrauded PhilHealth of funds, but some of them have already been suspended, others are being investigated, and a few others will soon be charged in court for criminal offenses.
“Congress first pointed out in July last year that a ‘mafia exists in the state agency, and they meant these cheating and colluding officials. Their sustained but sporadic activities do not qualify them as a ‘mafia’”•but they can be called economic saboteurs, Ferrer said.
Ferrer’s team has already launched a corporate-wide fraud detection and enforcement activities that “will catch the thieving, deceiving and villainous officials and their band of brothers among hospitals and other health care facilities.”
A few months into his tenure, Ferrer ordered a reshuffle of regional vice presidents who responded with threats, refusals and delaying tactics.
Ferrer also refuted Padilla’s claims that there was no review of the rates and over-payments.
On the contrary, he said, the assessments and studies had actually been conducted to see if the rates were appropriate, adequate and not excessive.
“We even reviewed the relative values scale for surgical procedures and the international classification of diseases. In 2014, a World Bank and the German cooperation agency GIZ sponsored a study in 2014 on such case rates, Ferrer said.
He said in 2017, PhilHealth came out with its new costs for pneumonia, while its coverage for hemodialysis sessions was cut by almost half. The studies and reviews did not always translate into adjustments in the rates, but they were useful in crafting policies and systems that contained costs and deterred fraud and abuse at the same time.
Those policies included pre-authorization protocols before an eye doctor could proceed with operating cataract patients; the putting of a limit for cataract operations to a maximum of 10 per day per eye doctor to a maximum of 50 operations per month.
PhilHealth also instituted a medical prepayment review wherein all claims were assessed first for their compliance with the policies and standards on quality care, Ferrer said.