Healthcare facilities with fraud cases granted IRM, PhilHealth officials admit

OFFICIALS of the Philippine Health Insurance Corp. (PhilHealth) admitted that the agency granted interim refund mechanism (IRM) even to healthcare facilities with pending cases of fraud.

Chairman of the House committee on public accounts and Anakalusugan Rep. Mike Defensor said this IRM should be scrapped.

“Nakakatakot na ito masyado, at talagag mauubos ang pondo ng PhilHealth,” Defensor said at the resumption of the joint hybrid hearing on the irregularities in PhilHealth. 

Cavite Rep. Elpidio Barzaga grilled PhilHealth officials regarding its policies, including its distribution of IRM funds to various healthcare facilities.

“Policy niyo ba rin sa IRM na ‘yung may mga pending cases, binigyan niyo pa rin ng IRM? Totoo ba ‘yun o hindi? Kahit na may pending cases sa PhilHealth, binigyan niyo rin ng IRM?” Barzaga asked.

IRM is an emergency cash advance measure of PhilHealth to provide hospitals with an emergency fund to respond to natural disasters, calamities, as well as other unexpected events such as the coronavirus pandemic.

It was PhilHealth senior vice president Israel Francis Pargas who confirmed that the agency granted the healthcare facilities with IRM despite fraudulent cases.

Earlier, Defensor disclosed that PhilHealth issued funds amounting to P1.49 billion to at least 51 healthcare facilities some of which have pending cases.

Barzaga pointed out that PhilHealth did not follow the circular it issued on the use of IRM.

“Malinaw na malinaw na PhilHealth circular na itong  IRM ay applicable lamang sa mga kaso involving fortuitous events, such as COVID-19,” Barzaga said.

The veteran solon pointed out that even dialysis centers, private birthing facilities and infirmaries were also given IRM.

Barzaga warned that officials could be facing technical malversation or illegal use of public funds.

Based on the documents, 4,664 fraud-related offenses of the 51 healthcare facilities were recorded from 2013 to 2020. And these cases include padding of claims, post-dating of claims, misrepresentation by furnishing false or incorrect information, fabrication or possession of fabricated forms and supporting documents.