Senate Majority Leader Juan Miguel Zubiri bared on Tuesday more schemes allegedly being used to defraud the Philippines Health Insurance Corporation (PhilHealth) of millions of government funds.

At the resumption of the Senate's investigation into the alleged anomalies in PhilHealth, Zubiri expounded on his recent discovery of some "fraudulent schemes" in the government insurance firm.

He brought up his information about the payments made by the PhilHealth for the treatment of "ghost" and non-existing patients, specifically to the Golingay General Hospital in Malalag, Davao del Sur.

With only an 18-bed capacity, the infirmary got P18 million in claims in 2014, and almost P10 million for the first semester of 2015. It joined the ranks of tertiary hospitals that received the most reimbursements for pneumonia claims, he said.

"How can an 18-bed hospital have so much patients? I was told by my insider these are what they called the non-existing patients, not only ghosts, but not existing at all," he said.

He hit the lack of "stringent legal actions" by PhilHealth despite the scandal last year about the "ghost" dialysis treatments it paid for.

Zubiri said he also got information that there are health care institutions (HCIs) that are still involved in the alleged upcasing of claims, wherein they pay people at least P1,000 to act as patients to claim for more serious ailments from the PhilHealth.

"Some provincial primary hospitals were once inspected by surprise by investigators from PhilHealth. Checking the logbook of the patients and inspecting the rooms and beds where the patients supposedly were, they found that the patients were not there," he said in his presentation.

"When asked the hospital staff would say that they will call the patients. And the patients will arrive and go back to their beds. When asked where they came from ang sagot, 'Nagpakain lang sila ng baboy (They just fed their pigs)' and of course other absurd excuses," he added.

Some patients, he added, were given Losartan for hypertension then claim the cases as mild stroke to charge the state insurer as much as P25,000 per claim, while others send the patients home but would ask the PhilHealth to pay for rooms and medicines. 

Some have three to four "ghost" patients, whose claims earn as high as P100,000 per week.

"This is blatant fraud and corruption, which is utilizing the funds and the money that should go to the proper patients that need out help," Zubiri said.

Aside from these, Zubiri also alleged that some PhilHealth officials have been asking for kickback from hospitals that are asking for rebates.

Such scheme has been existing as early as 2014, he said, when a certain Dr. David Gosengfiao was allegedly asked to pay P7.3 million for the release of his multi-million peso claim on cataract removal surgeries and other eye operations.

Zubiri asked the committee to invite Gosengfiao to its next hearing.

He also mentioned immediate reimbursements by PhilHealth to specific private HCIs, while deferring payments to government hospitals that actually cater to COVID-19 patients; as well as the "unbelievable" overpricing of the information technology equipment that the PhilHealth wants to procure.

The Senate leader blamed the PhilHealth management for the continued proliferation of these schemes. He said its legal sector gave orders "to ignore court rulings on fraud."

"Supreme Court (SC) and Court of Appeals (CA) final decisions on suspension of hospitals have remained unimplemented or ignored by PhilHealth,” he said. 

He cited the CA decision on Perpetual Succor Hospital in Cebu, and the SC decision sustaining the suspension of General Santos Doctors Hospital which was found guilty of claiming payments for ghost patients. The former remains unenforced, while the latter has been put on hold, he said.

"This sends a wrong signal, Mr. President, kaya walang natatakot na HCIs dahil nga hindi naman sila kinakasuhan at hindi sila pinaparusahan (that's why HCIs remain fearless, because they know that they will be charged or penalized)," Zubiri said.

The PhilHealth, he said, has also been filing "diluted" administrative charges against its erring officials and employees, resulting in the dismissal of cases despite "clear evidence" of their involvement in anomalies.

"Paano natin maaayos ang katiwalian sa PhilHealth kung wala 
namang kaso na fina-file at wala pong mga taong ikinukulong (How will we get rid of corruption in PhilHealth if no cases are filed and no one is sent to jail)?" he asked.