Two whistleblowers have revealed that fraudulent schemes have been employed by Philippine Health Insurance Corporation (PhilHealth) officers and employees in collusion with doctors and hospitals for a number of years, the Department of Justice (DOJ) said on Saturday, Aug. 15.
“These schemes include the payment of false or fraudulent claims against the corporation, malversation of premiums, and the exploitation by some unscrupulous personalities of the case rate system and the interim reimbursement mechanism, among others,” the DOJ said in a statement.
The DOJ said that two PhilHealth insiders narrated their knowledge on these corrupt activities during the first hearing conducted by Task Force PhilHealth on Friday, Aug. 14.
The department declined to identify the two whistleblowers who requested anonymity.
The DOJ said the two resource persons told the task force that the different fraudulent schemes were “allegedly employed through the years by PhilHealth officers and employees, both at its main office and regional offices, in collusion with some doctors and hospitals, and even banks which act as remittance centers.”
“The resources persons likewise highlighted abuses and flaws in the corporation’s Legal Department and Information Technology office that allegedly made the proliferation of these schemes possible,” it added.
Justice Secretary Menardo Guevarra formed Task Force PhilHealth last August 7 pursuant to the directive of President Duterte who wanted the state-run insurer investigated over corruption allegations.
The task force, which has Guevarra as conveneris composed of representatives from the DOJ, Office of the Ombudsman, the Commission on Audit, the Civil Service Commission, the Presidential Anti-Corruption Commission, the Office of the Special Assistant to the President, the Anti-Money Laundering Council, the National Bureau of Investigation and the National Prosecution Service.
“They agreed to conduct hearings as a whole even as member agencies continue their respective investigations and audits,” the DOJ said.
Members also agreed that “any action by the agencies regarding PhilHealth will be coordinated through the Task Force and any action towards the prosecution of PhilHealth officers and employees and their cohorts will (also) be made through the Task Force and with the endorsement of the Secretary of Justice.”
“The participating agencies in the Task Force likewise reported the investigations currently pending with them, and undertook to expedite the completion of their work with the assistance of the Task Force,” the DOJ said.
“They likewise agreed to harmonize efforts in the lifestyle checks currently underway and to be conducted by the different offices and agencies,” it added.