The Senate has recommended that the Philippine Health Insurance Corp. (PhilHealth) require all health care institutions (HCIs) that received the controversial Interim Reimbursement Mechanism (IRM) funds to liquidate the amount disbursed to them and return any unutilized money.
Senate President Vicente Sotto III, reporting on the findings of the committee of the whole on its investigation on the recent anomalies hounding the state health insurance agency, said it is imperative that PhilHealth properly liquidate any funds released under its IRM policy to ensure transparency.
PhilHealth must also impose a definite deadline and strictly implement this, Sotto said.
Likewise, the Senate leader said, PhilHealth should also immediately pay the claims of private
hospitals, prioritizing those hospitals where COVID-19 patients have been referred to and hospitals that have high cases of COVID-19 admissions.
He also said there is also an urgent need to increase the involvement of the Commission on Audit (COA) in every stage of operations of PhilHealth.
“As revealed in the hearings, COA is having a hard time in auditing PhilHealth due to the difficulty of obtaining documents from PhilHealth Central Office,” Sotto said.
“COA should be allowed to pursue its mandate to conduct the necessary audits even at the Regional Level without any hindrance from PhilHealth to ensure that government funds are properly managed and spent,” he added.
During the hearings, the Senate investigated the questionable release of IRM funds which, instead of being a system of reimbursement, became a system where PhilHealth pays hospitals and healthcare facilities in advance.
Due to the congressional probe, PhilHealth temporarily suspended the program.
The Senate committee of the whole, also recommended that PhilHealth outsource its Information Technology (IT) services to a reputable company.
He said the IT service company it should contract must include, but not limit, the development and provision of a reliable electronic health records and analytics system, specifically for membership data information collection and membership services.
“For PhilHealth to contract out the processing of its benefits claim to avoid backlogs and massive reimbursement delays; this would simplify the reimbursement process, remove red tape, and address corruption,” Sotto said.
Apart from irregularities in the IRM policy, the Senate also probed the alleged overpriced IT system project of PhilHealth.
It was Senate minority leader Franklin Drilon who earlier suggested that PhilHealth source out its IT requirements and find a reliable and competent IT service company to automate and update its database to address corruption.