ADVERTISEMENT

'PhilHealth IT systems can't detect fraud'

Published Aug 20, 2020 02:54 pm

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.

(MANILA BULLETIN)

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.”

ADVERTISEMENT
.most-popular .layout-ratio{ padding-bottom: 79.13%; } @media (min-width: 768px) and (max-width: 1024px) { .widget-title { font-size: 15px !important; } }

{{ articles_filter_1561_widget.title }}

.most-popular .layout-ratio{ padding-bottom: 79.13%; } @media (min-width: 768px) and (max-width: 1024px) { .widget-title { font-size: 15px !important; } }

{{ articles_filter_1562_widget.title }}

.most-popular .layout-ratio{ padding-bottom: 79.13%; } @media (min-width: 768px) and (max-width: 1024px) { .widget-title { font-size: 15px !important; } }

{{ articles_filter_1563_widget.title }}

{{ articles_filter_1564_widget.title }}

.mb-article-details { position: relative; } .mb-article-details .article-body-preview, .mb-article-details .article-body-summary{ font-size: 17px; line-height: 30px; font-family: "Libre Caslon Text", serif; color: #000; } .mb-article-details .article-body-preview iframe , .mb-article-details .article-body-summary iframe{ width: 100%; margin: auto; } .read-more-background { background: linear-gradient(180deg, color(display-p3 1.000 1.000 1.000 / 0) 13.75%, color(display-p3 1.000 1.000 1.000 / 0.8) 30.79%, color(display-p3 1.000 1.000 1.000) 72.5%); position: absolute; height: 200px; width: 100%; bottom: 0; display: flex; justify-content: center; align-items: center; padding: 0; } .read-more-background a{ color: #000; } .read-more-btn { padding: 17px 45px; font-family: Inter; font-weight: 700; font-size: 18px; line-height: 16px; text-align: center; vertical-align: middle; border: 1px solid black; background-color: white; } .hidden { display: none; }
function initializeAllSwipers() { // Get all hidden inputs with cms_article_id document.querySelectorAll('[id^="cms_article_id_"]').forEach(function (input) { const cmsArticleId = input.value; const articleSelector = '#article-' + cmsArticleId + ' .body_images'; const swiperElement = document.querySelector(articleSelector); if (swiperElement && !swiperElement.classList.contains('swiper-initialized')) { new Swiper(articleSelector, { loop: true, pagination: false, navigation: { nextEl: '#article-' + cmsArticleId + ' .swiper-button-next', prevEl: '#article-' + cmsArticleId + ' .swiper-button-prev', }, }); } }); } setTimeout(initializeAllSwipers, 3000); const intersectionObserver = new IntersectionObserver( (entries) => { entries.forEach((entry) => { if (entry.isIntersecting) { const newUrl = entry.target.getAttribute("data-url"); if (newUrl) { history.pushState(null, null, newUrl); let article = entry.target; // Extract metadata const author = article.querySelector('.author-section').textContent.replace('By', '').trim(); const section = article.querySelector('.section-info ').textContent.replace(' ', ' '); const title = article.querySelector('.article-title h1').textContent; // Parse URL for Chartbeat path format const parsedUrl = new URL(newUrl, window.location.origin); const cleanUrl = parsedUrl.host + parsedUrl.pathname; // Update Chartbeat configuration if (typeof window._sf_async_config !== 'undefined') { window._sf_async_config.path = cleanUrl; window._sf_async_config.sections = section; window._sf_async_config.authors = author; } // Track virtual page view with Chartbeat if (typeof pSUPERFLY !== 'undefined' && typeof pSUPERFLY.virtualPage === 'function') { try { pSUPERFLY.virtualPage({ path: cleanUrl, title: title, sections: section, authors: author }); } catch (error) { console.error('ping error', error); } } // Optional: Update document title if (title && title !== document.title) { document.title = title; } } } }); }, { threshold: 0.1 } ); function showArticleBody(button) { const article = button.closest("article"); const summary = article.querySelector(".article-body-summary"); const body = article.querySelector(".article-body-preview"); const readMoreSection = article.querySelector(".read-more-background"); // Hide summary and read-more section summary.style.display = "none"; readMoreSection.style.display = "none"; // Show the full article body body.classList.remove("hidden"); } document.addEventListener("DOMContentLoaded", () => { let loadCount = 0; // Track how many times articles are loaded const offset = [1, 2, 3, 4, 5, 6, 7, 8, 9, 10]; // Offset values const currentUrl = window.location.pathname.substring(1); let isLoading = false; // Prevent multiple calls if (!currentUrl) { console.log("Current URL is invalid."); return; } const sentinel = document.getElementById("load-more-sentinel"); if (!sentinel) { console.log("Sentinel element not found."); return; } function isSentinelVisible() { const rect = sentinel.getBoundingClientRect(); return ( rect.top < window.innerHeight && rect.bottom >= 0 ); } function onScroll() { if (isLoading) return; if (isSentinelVisible()) { if (loadCount >= offset.length) { console.log("Maximum load attempts reached."); window.removeEventListener("scroll", onScroll); return; } isLoading = true; const currentOffset = offset[loadCount]; window.loadMoreItems().then(() => { let article = document.querySelector('#widget_1690 > div:nth-last-of-type(2) article'); intersectionObserver.observe(article) loadCount++; }).catch(error => { console.error("Error loading more items:", error); }).finally(() => { isLoading = false; }); } } window.addEventListener("scroll", onScroll); });

Sign up by email to receive news.