JUSTICE Undersecretary Markk Perete yesterday disclosed that three officials of the Philippine Health Insurance Corporation (PhilHealth) testified before Task Force PhilHealth.
Perete said that PhilHealth senior vice president and chief information officer Jovita Aragona, corporate secretary Jonathan Mangaoang and acting denior manager of PhilHealth’s fact-finding investigation and enforcement division (FFIED) Ernesto Barbado responded to queries on various issues propounded by the members of the Task Force.
Aragona admitted to the inability of the current IT systems of PhilHealth to detect fraudulent claims, saying the segments in the corporation’s validation processes that are still done manually.
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.
Aragona also clarified that the previously reported questionable procurement of switches was a transaction of the PhilHealth National Capital Region office. She called for an investigation to be conducted on said office.
Meanwhile, Mangaoang stressed that the controversial Interim Reimbursement Mechanism (IRM) was proposed in January 2020 to ensure that hospitals and medical establishments remain financially viable in case of emergencies and fortuitous events.
He noted that the PhilHealth Board approved the IRM based on an opinion issued by the corporation’s Legal Sector.
Mangaoang likewise confirmed that the Board has approved the recommendation by the corporation’s Protest and Appeals Department to grant amnesty to hospitals that belatedly filed claims for reimbursement from 2011 onwards.
The law that created PhilHealth renders ineligible for reimbursement a claim filed beyond sixty (60) days from the discharge of a patient.
For his part, Barbado asked the Task Force to look into certain ghost or fake claims previously investigated by the FFIED.
Before taking the testimony of these officials, the Task Force agreed to establish composite teams tasked to thoroughly investigate the Information Technology and Legal Sectors of the PhilHealth.
The composite teams were directed to, among others, conduct further interviews, gather evidence, conduct audits, and report their findings to the Task Force.