Hospital owners, administrators invited to House hearings to explain PhilHealth fraud cases

Hospital owners and administrators with pending cases of alleged fraudulent insurance claims from the Philippine Health Insurance Corp. (Philhealth) will be summoned by the House of Representatives.

Most sought by lawmakers is the presence of officials of the Tamparan Medical Foundation in Lanao del Sur  and the  Butuan Doctors Hospital and College  in Agusan del Norte.

TMF has 431 pending cases while the BDHC with 226.  The Baguio General Hospital, Fabiola Gabriel Center and Notre Dame de Charles Hospital each have 129, 99, 91 cases, respectively.

Anakalusugan Partylist Rep. Michael Defensor, chairman of the House Committee on Public Accounts, said he wants the House panel to dig into the cases that became the source of massive fund losses of the state insurer.

“Fraud, to my mind, is committed with the (connivance of ) hospitals,” said Defensor.

The lawmaker presided over the congressional inquiry into the alleged PhilHealth fund irregularities for over ten hours on Monday.

 Together with the House Committee on Good Government and Public Accountability, Defensor’s panel continued its inquiry on Tuesday, but this time, they focused on PhilHealth’s failed bid to impose higher medical health premiums on overseas Filipino workers.

“We have to understand how it is being done. For example, sa pneumonia dapat may X-ray. Paano kung may usapan and hindi na i - require? (For example, X-ray is needed for pneumonia.  What happens if there is an agreement to cancel it), “  said Defensor.

He added: “Mayroon fraud cases na outstanding since 2013 to 2018. We want to know the nature of the cases and understand how fraud is committed in PhilHealth. (There are fraud cases that have been outstanding since 2013 to 2018) “

Deputy Speaker and Laguna Rep. Dan Fernandez, together with Reps. Elpidio Barzaga (NUP, Cavite) and Jonathan Sy-Alvarado (NUP, Bulacan), are convinced that collusion to defraud PhilHealth involved top executives down to regional personnel and their cohorts in hospitals.

 During Monday’s hearing, Defensor disclosed that at least 51 hospitals with still unresolved cases of fraud received a total of P1.49 billion in interim refund mechanism fund despite the complaints filed against them.

Among the hospitals mentioned by Defensor were top medical centers in Metro Manila that included the Capitol Medical Center, Chinese General Hospital, Cardinal Santos Medical Center, Victor Potenciano Medical Center,  FEU  Dr. Nicanor Reyes Medical Foundation; Manila Doctors Hospital; Marikina Valley Medical Center, Our Lady of Lourdes Hospital; St. Luke’s Medical Center, the Medical City and the Hospital of the Infant Jesus Medical Center.  All are Level 3 hospitals.

The IRM funding of P14 billion was released by PhilHealth to fund COVID-19 cases in the hospitals but Defensor noted that even dialysis centers benefited from the “cash advance.”

Defensor said PhilHealth must clarify why the state-run firm distributed millions of pesos to each of the 51 hospitals despite the fact that fraud cases being investigated against them have yet to be resolved.

These hospitals each received P4 million to over P100 million in IRM or emergency  funds advanced by the insurer to cover claims of hospitalized members due to natural disasters, epidemic or other fortuitous events.