The House Committee on Public Accounts is investigating the alleged irregularities and “systemic” corruption in the State-owned Philippine Health Insurance Corp. (PhilHealth) on Wednesday.
Anakalusugan partylist Rep. MIchael “Mike” Defensor, chairman of the panel, said the investigation was initially scheduled on Monday but they decided to reschedule it to Wednesday to ensure that invitations have been sent out to resource persons.
“Sa Wednesday tayo (We will conduct the hearing on Wednesday), kasi dapat nga bukas talaga itong hearing (the hearing was initially scheduled tomorrow) pero (but) nakiusap sila (they appealed) na Wednesday na isagawa (that it be conducted on Wednesday) dahil sa kailangan ng oras sa imbitasyon (because more time is needed to send out invitations),” Defensor said.
He said among those who are expected to attend the hearing are PhilHealth president and chief executive officer Ricardo Morales and former PhilHealth anti-fraud legal officer Thorrsson Keith who claimed that top agency officials are involved in the corruption.
In a statement, Defensor said they are expecting Keith to shed light more on his allegations that millions of overseas Filipino workers should not be burdened to pay for the “spillages” of the agency as stated in his resignation letter.
“Mr. Keith should explain what these spillages are, what are the instances of corruption in the State health insurance firm, and who are the officials and personnel involved,” he said.
Keith’s resignation letter was circulated on social media. In that letter, he stated that his salary has not been given on time since he started investigating PhilHealth officers allegedly involved in the corruption.
“It should be noted that the PhilHealth has had its share of corruption issues in the past,” Defensor said
He recalled that in June this year, Malacañang called out the PhilHealth for its supposed inaction to look into the missing P154-billion funds within the agency through “fraudulent schemes.”
The House leader cited that in August 2019, the Commission on Audit (CoA) also called out PhilHealth for the surge in the number of cases and reimbursement claims of members, particularly those from Rizal and Metro Manila for pneumonia, urinary tract infection, acute gastroenteritis, sepsis, and other diseases.
He attributed that tens of billion in “overpayments” to the prevailing all-case rates (ACR) payment mechanism.
“The case-rate system, under which there is a fixed cost for the treatment of certain diseases and for procedures, is really a loophole that is resulting in billions of losses on the part of PhilHealth. It is not surprising that it maybe a source of corruption,” he said.
According to him, under the ACR payment mechanism, PhilHealth pays the hospital the “case rate even if the cost incurred by a member is much, much less.”
“For instance, the case package for mild pneumonia is about P44,000. A hospital could declare that it treated a PhilHealth member for pneumonia even if he had only colds and fever,” he said.
He laments that in some instances, a simple eye procedure was claimed as a cataract operation.
Defensor said the PhilHealth should bill the actual cost of treatment or procedure, and that the case rates be declared as cost limits.
He asked the PhilHealth officials to look into numerous claims for payment or reimbursement for the same or similar diseases or procedures, and involving the same doctors, clinics, or hospitals.
“This has happened with pneumonia, eye problems, and dialysis and kidney ailments. They should have learned their lesson. It cannot continue to happen, unless some officials and personnel are involved in corruption,” he said.
Defensor had filed House Resolution No. 1069 seeking motu proprio investigation on the corruption issues hounding PhilHealth that led to the resignation of several personalities.
“When there seems to be a pattern of alleged abuses where loopholes can be taken advantage of by the unscrupulous, a systemic change needs to be done to overhaul the present set up,” he said.