Certain Philippine Health Insurance Corporation (PhilHealth) officials have shown negligence in handling the funds of the state firm and failed to investigate and prosecute wrongdoing, according to the probe findings of a government task force.
Presidential spokesman Harry Roque released a summary of the findings of the corruption probe conducted by the Department of Justice-led panel during his televised press briefing Tuesday.
(OPS / FILE PHOTO / MANILA BULLETIN)
The task force earlier recommended the filing of charges against PhilHealth President Ricardo Morales and other high-ranking officials over alleged anomalies. The recommendation was approved by President Duterte during a meeting with some Cabinet members Monday night.
"Persons who are supposed to set the policies and operational guidelines for the management of the Philippine Health Insurance Corporation – the Board of Directors and the Executive Committee – have not shown the due diligence required of them in the discharge of their duties, particularly in the disbursement of the National Health Insurance Fund," Roque said, sharing the findings of the task force PhilHealth report.
IRM releases
He said the PhilHealth officials' "lack of diligence and due care" has allegedly been shown in their approval and implementation of the Interim Reimbursement Mechanism (IRM) without sufficient standards.
They also allegedly approved PhilHealth’s ICT budget based on a mere representation by the senior vice president who claimed the management information system would collapse unless such budget was approved.
The PhilHealth officials also supposedly adopted corporate policies and practices that "fail to check, investigate, prosecute and penalize the wrongdoing of PhilHealth personnel as well as health care institutions and professionals," according to Roque.
He said the task force also found out that the PhilHealth executive committee and board showed "lack of due care, if not outright negligence, in approving and implementing the IRM." The IRM fund releases were "rushed" even though the circular implementing the scheme was not yet effective.
"In converting the IRM into a special privilege, the circular removed the need for prior Board approval. It likewise removed a number of requirements previously imposed upon HCIs (health care institutions) such as survey and post-survey requirements which were designated to assess and document the damage or condition of the HCI) and centralized the evaluation of IRM Fund beneficiaries at the Office of the PCEO," the report read.
The task force also found out that IRM fund releases were made despite the absence of mechanisms to monitor fund utilization and liquidation, and without taxes being withheld.
Concealment of information on ICT procurement
Roque said the members of the PhilHealth executive committee also supposedly engaged in "concealment" of important information or documents to obtain Board approval on ICT procurement.
The members of the executive committee proposed to the board a P734-million budget for the procurement of ICT resources items for 2020 but the items were neither included in PhiHealth’s Information System Strategic Plan (ISSP) nor approved by the Department of Information and Communications Technology as required by law.
The task force also discovered the Internal Audit Report (IAR) that showed discrepancies or inconsistencies in the PhilHealth's inventory of hardware and software was also not presented to the board.
The board also supposedly approved a proposal to procure network switches for the PhilHealth Regional Office at the National Capital Region (PRO NCR) despite a Commission on Audit (COA) report that 24 similar switches have not been used.
Weak enforcement policies
According to Roque, the task force probe also showed the PhilHealth management adopted "questionable policies and weak enforcement practices that failed to check, investigate, prosecute, and penalize wrongdoing."
It said the PhilHealth management has adopted a policy towards settlement of claims without accountability, and even grant of "wholesale amnesty" in favor of HCIs with claims that appear to be no longer enforceable against the corporation.
Cases involving fictitious crediting of remittances were allegedly "settled," according to Roque.
Instead of complying with a court decision on the penalty of suspension on six HCIs, the PhilHealth board changed it to mere payment of fines. The board also withheld suspension and did not pursue legal action against 20 HCIs in exchange for payment of fines.
The task force also discovered the PhilHealth board approved the amnesty to HCIs whose claims had been denied on account of late filing or re-filing. The total claims included in the amnesty reached more than P687 million.
Thousands of cases involving HCIs and PhilHealth employees have not yet been filed, according to the report.
Based on the investigation of the Senate, the task force noted that less than two-thirds of the 7,452 pending cases against HCIs from 2010-2019 had been acted upon by the corporation. Around 1/3 of the 1,968 cases of fraudulent claims from 2000 to 2019 had been decided.
Administrative and criminal liability
The task force report states that the negligence of some officers of the PhilHealth executive committee gives rise to administrative and criminal liability. It recommended the filing of charges against concerned officials for violation Republic Act No. 3019 for Graft and Corrupt Practices Act; the Revised Penal Code for Malversation of Public Funds or Property and Illegal Use of Public Funds or Property; and Gross Misconduct and Gross Neglect of Duty under Civil Service Laws, according to the report.
Administrative complaints have also been recommended against some PhilHealth officials for alleged “dishonesty, gross neglect of duty, grave misconduct, falsification of official documents, disloyalty to the Republic of the Philippines and the Filipino people, inefficiency and incompetence in the performance of official duties, and/or conduct prejudicial to the best interest of the service.”