‘Mafia’ in PhilHealth conniving with private hospitals in ‘fraudulent schemes’ --- Sen. Zubiri

Members of the so-called "mafia" in the Philippine Health Insurance Corporation (PhilHealth) are allegedly conniving with private health care institutions (HCIs) to defraud the state insurer of millions of funds.

Sen. Juan Miguel Zubiri
(Senate of the Philippines / FILE PHOTO / MANILA BULLETIN)

Senate Majority Leader Juan Miguel Zubiri bared this Wednesday as he cited insider information that the group was involved in the alleged anomalous transactions concerning the state-run insurance firm.

"Ang balita sa akin, malakas daw 'yong mafia dahil hawak nila itong mga private institutions na ito (I was told that this mafia was influential because they control these private institutions). If you notice, hindi nila masyadong nagagawa ito sa public institutions, bakit (they cannot do it with public institutions, why)? May COA, eh (Because there's the Commission on Audit)," Zubiri told reporters in a virtual briefing.

During the hearing of the Senate Committee of the Whole on the alleged anomalies in the PhilHealth, Zubiri disclosed the "fraudulent schemes" in the agency.

The schemes include the claims being made by some unscrupulous HCIs for their treatment of patients who are either deceased or non-existent; and the alleged upcasing and fabrication of illnesses to charge the health insurer of heftier claims.

Aside from these, the Senate leader also alleged that some PhilHealth officials have been asking for "kickbacks" from hospitals.

"Napakahirap kumuha ng kickback sa government hospitals, paano ka naman maka-kickback doon (It would be difficult for them to ask for kickback from government hospital, how would they be able to do it)? Mahuhuli't mahuhuli yon dahil unang-una, may resident COA sa kanila (They would always be caught because first of all, they have resident COA auditors in the agency)," Zubiri said Wednesday.

"If you notice, 'yong bayaran, usually opisyal lang ng Philhealth at may-ari ang nakikipag-usap eh (the payments usually happen between the officials of the PhilHealth and the owners of the private HCIs). So pag sinabi ng may-ari na 'Huwag kang mag-alala, meron ka dyan', wala na, delikado na (So when the owner assures the officials that 'Don't worry, you will have your share', then it's game over)," he added.

Zubiri agreed with his fellow senators that private dialysis centers have become the "favorite" conduits for corruption in the PhilHealth.

"Our insiders tell me that it's easier to connect with the owners and come up with, I guess, special favors...Talagang nagkakaroon ng favoritism lalo na sa  mga centers na ito dahil mabilis daw ang rebate (There is indeed favoritism especially toward these centers because the rebates are quick). What is that 'rebate'? Kickback," he said.

He said the PhilHealth should strengthen its legal department to pursue charges against errant officials and health care facilities. Penalties should also be increased for the PhilHealth officials who fail to act on cases of fraud.

Zubiri also supported a proposal to legislate the establishment of government-run dialysis centers to compete with private facilities and make sure that the payments indeed benefit legitimate partient.

This would also give poor patients access to more affordable kidney treatments, he said.