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PhilHealth’s ills: corruption and more

"Here’s a law professor on the problems that hound our state health insurer."

 

(Part 1)

The corruption in PhilHealth is not the only ill the agency is suffering from—it is also plagued internally by people who seemingly do not know how to do their job properly and it is this mismanagement and incompetence that have resulted in a narrowly averted crisis.

Consider the present situation of the pandemic: Europe is suffering its second surge. The United States hit a record-high number of cases last weekend. Worldwide, 43 million people have been infected and more than 1.5 million have died. There is no safe and reliable vaccine on the horizon and all we can do to keep ourselves safe is to wear masks, wash our hands regularly, and practice social distancing and contact tracing.

Effective contact tracing goes hand-in-hand with accurate swab testing―testing that is competently being conducted by the Philippine Red Cross (PRC), whose frontliners have contributed much to the nation’s pandemic response. 

However, the Red Cross halted their testing efforts on Oct. 14 because of PhilHealth’s failure to pay their gargantuan debt of P1.1 billion to the organization.

It wasn’t until a tide of negative public opinion, and consequently, President Rodrigo Duterte’s wrath, were turned on the agency that they coughed up P500 million in  partial payment, leading the PRC to resume testing on Oct. 27.

PhilHealth implements the National Health Insurance Program which gives the poor, who constitutes the majority of our people, access to medical care at the time they need it most.

Unfortunately, the corruption in PhilHealth committed at an unprecedented scale has directly threatened the safety and well-being of our kababayan.  On Tuesday, two House committees recommended the filing of criminal charges against officials connected with the agency, including Health Secretary Francisco Duque III and former PhilHealth President and CEO Ricardo Morales.

To obtain a clear understanding of the interplay of health insurance and criminal liability, I called, via videoconference, lawyer Saul Hofileña Jr., who taught insurance law and criminal law at San Beda College.

Atty. Hofileña said graft and corruption are not the only problems that plague Philhealth, but also “people [in the agency] who by force of habit disregard the law.” 

He cited the case of opthalmologist Mario Reyes, who was suspended by PhilHealth after the Philippine Academy of Ophthalmologists (PAO) suspended him from its membership from December 1, 2014 until November 30, 2026. Reyes, who hosts a program on Radio Veritas, was formerly head of Ospital ng Maynila’s ophthalmology department.

PhilHealth’s suspension of Reyes’ accreditation for the same period as that of PAO was based on nothing but the PAO ruling. After years of litigation, in July 2019 the Supreme Court, in the case of Dr. Mario Reyes, M.D. vs. Philippine Health Insurance Corporation (G.R. No. 241062), declared in a unanimous decision and with finality the continued suspension of Reyes as illegal.

After the Supreme Court released its decision, Dr. Reyes sought reaccreditation with PhilHealth. However, PhilHealth Area Vice President Gregorio C. Rulloda, in a letter dated June 16 this year, denied his request, writing that Reyes is “still under definite suspension to be served completely until November 30, 2026” (sic) and therefore, according to Rulloda’s letter, “said act (sic) cast doubts on his capability and integrity to provide services to PhilHealth members.”

Hofileña said Rulloda’s response was “in defiance of the final ruling of the Supreme Court mandating the illegality of the suspension of Dr. Reyes.”

He added that a final Supreme Court decision is considered as law between the parties and therefore Philhealth’s response denying Reyes’ request, citing the  period of suspension, “is an actionable wrong.”

“Ignorance is not an excuse, especially in law,” he said. “The maxim is so timeworn that it is written in Latin, a dead language now only spoken by a few members of the clergy.”

When asked to explain, Hofileña said the decision in the Reyes case “has long become final and has been irrevocably established as the controlling law of the case between the parties.

“The stability and conclusiveness given to final judgments of courts of competent jurisdiction are grounded on reasons of public policy and the protection of the time and interest of the litigants.”

“Those in government should follow the law,” he added. “The act of Rulloda subjects him to possible criminal and administrative action, and the agency to civil liability since they have placed themselves above the law by insisting on the tenability of a position struck down as illegal by the Supreme Court.”

Hofileña also said: “It would be worse if he did not know of the existence of the Supreme Court decision against Philhealth because unfortunately, there is no vaccine for the clueless.”

Meanwhile, the Office of the Ombudsman on Wednesday placed Rulloda and seven other PhilHealth officials under six months’ preventive suspension without pay for their “alleged anomalous release of P2.7 billion worth of PhilHealth funds under the Internal Reimbursement Mechanism policy,” according to a Manila Standard news report.

(To be continued)

 

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

Topics: Jenny Ortuoste , PhilHealth , corruption , Philippine Red Cross
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