One month after Anak kalusugan partylist Rep. Mike Defensor, chairman of the House of Representatives Committee on Public Accounts, charged that the Philippine Health Insurance Corp. (PhilHealth) lost P153.76 billion from 2013 to 2018 due to overpayments and fraud, various irregularities have been charged in its operations, and the names of so many officials have come up in a negative light.
The Senate Blue Ribbon Committee led by Sen. Richard Gordon joined in the inquiry and the Department of Justice led by Secretary Menardo Guevarra launched its own investigation.
In 2011, PhilHealth had set up a “Case Rate System” under which it assigned specific amounts as costs for treating various diseases. The hospital package cost for COVID-related pneumonia, for example, is P44,000. Even if a hospital spends only P15,000 or P20,000 on a PhilHealth member, PhilHealth pays it P44,000.
PhilHealth also has what it calls an Interim Reimbursement Mechanism (IRM). In case of natural disaster, PhilHealth advances the total amount, even before a patient gets well and before the hospital determines the actual cost of hospitalization.
The Case Rate System is “the root of all evil and corruption” in PhilHealth, Defensor said at a recent inquiry, “and the IRM is its offspring.” The millions of pesos in PhilHealth losses over the years have been blamed on a “mafia” of officials in the agency who took advantage of these two systems.
The National Bureau of Investigation said it has also found that P114 million in premium contributions of PhilHealth members were diverted to various bank accounts instead of going to PhilHealth in 2011. The Senate Blue Ribbon Committee said it has also found gross overpricing in the purchase of equipment.
Senator Gordon has called for the abolition of PhilHealth and its replacement by a new agency. It may eventually lead to that but in the meantime, the Department of Justice must determine the culpability of the accused officials, with such evidence as their bank accounts. Its findings are to be assessed by the Ombudsman which may then file charges of plunder.
President Duterte has vowed to clean up the agency and prosecute the corrupt officials concerned. This may take some time but the PhilHealth case has become so big that all possible means must be taken to speed it up so it will be resolved within these last two years of the Duterte administration.