‘PhilHealth IT systems can’t detect fraud’

Published August 20, 2020, 2:54 PM

by Jeffrey Damicog

An executive of the Philippine Health Insurance Corp. (PhilHealth) has admitted before the task force investigating anomalies at the State-run health insurer that its Information Technology (IT) systems are incapable of detecting fraudulent claims, the Department of Justice (DoJ) said Thursday.


DOJ Undersecretary Markk Perete said this problem was pointed out by PhilHealth Senior Vice President and Chief Information Officer Jovita Aragona during her testimony before Task Force PhilHealth Wednesday.

“Aragona admitted to the inability of the current IT systems of PhilHealth to detect fraudulent claims,” the DoJ spokesman said in a statement.

“She attributed the current lack of validation mechanism in the corporation’s IT systems to the alleged failure of its relevant offices to specify their required internal control systems during the design and development of the IT systems,” he said.

Aside from this, Aragona also said that the corporation’s validation processes are “still done manually.”

Because of the lack of detection of fraudulent claims, Aragona said the PhilHealth had plans “to develop a more sophisticated IT systems in the future.”

During her testimony, Aragona urged the task force to look into the questionable procurement of network switches that was made by the PhilHealth National Capital Region (NCR) office.

Aside Aragona, Perete said two other PhilHealth officials testified before the task force Wednesday — Corporate Secretary Jonathan Mangaoang and Fact-Finding Investigation and Enforcement Division (FFIED) acting Senior Manager Ernesto Barbado.

Though the law creating PhiliHealth does not allow claims reimbursement 60 days after the discharge of a patient, Mangaoang told the task force the PhilHealth board approved the recommendations of the Protest and Appeals Department “to hospitals that belatedly filed claims for reimbursement from 2011 onwards.”

Mangaoang also testified that the PhilHealth board approved the controversial Interim Reibursement Mechanism (IRM) based on the opinion of the Legal Sector in January and was intended “to ensure that hospitals and medical establishments remain financially viable in case of emergencies and fortuitous events.”

Barbado asked the task force to look into certain ghost or fake claims previously investigated by the FFIED.

Justice Secretary Menardo Guevarra formed the task force on Aug. 7 and has served as convenor pursuant to the directive of President Duterte who wanted the State-run health insurer investigated over corruption allegations.

The task force is composed of the DoJ, the Presidential Anti-Corruption Commission (PACC), Office of the Ombudsman (OMB), the Commission on Audit (CoA), the Civil Service Commission (CSC), the Office of the Special Assistant to the President (OSAP), the Anti-Money Laundering Council (AMLC), the National Bureau of Investigation (NBI), and the National Prosecution Service (NPS).

Duterte gave the task force 30 days starting from its creation to submit to him “its findings and recommendations, which shall include, proposed legal actions against officials and employees found responsible for acts of corruption and anomalies in PhilHealth.”