Fraudulent schemes at PhilHealth bared

August 15, 2020
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TASK Force PhilHealth yesterday held its first investigative hearing with two individuals formerly connected with the Philippine Health Insurance Corporation as resource persons.

The individuals (who requested anonymity) informed the Task Force of the different fraudulent schemes allegedly employed through the years by PhilHealth officers and employees, both at its main office and regional offices, in collusion with some doctors and hospitals, and even banks which act as remittance centers.

These schemes include the payment of false or fraudulent claims against the corporation, malversation of premiums, and the exploitation by some unscrupulous personalities of the case rate system and the interim reimbursement mechanism, among others.

The resources persons also highlighted abuses and flaws in the corporation’s Legal Department and Information Technology office that allegedly made the proliferation of these schemes possible.

Before the hearing, members of the Task Force – convened by the Secretary of Justice upon orders of the President – met to discuss administrative and logistical matters relating to their work.  They agreed to conduct hearings as a whole even as member agencies continue their respective investigations and audits.  It was however agreed that any action by the agencies regarding PhilHealth will be coordinated through the Task Force and any action towards the prosecution of PhilHealth officers and employees and their cohorts will be made through the Task Force and with the endorsement of the Secretary of Justice.

The participating agencies in the Task Force likewise reported the investigations currently pending with them, and undertook to expedite the completion of their work with the assistance of the Task Force.  They likewise agreed to harmonize efforts in the lifestyle checks currently underway and to be conducted by the different offices and agencies.

Justice Secretary Menardo Guevarra is convenor of the Task Force that counts among its members the Office of the Ombudsman, the Commission on Audit, the Civil Service Commission, the Presidential Anti-Corruption Commission, the Office of the Special Assistant to the President, the Anti-Money Laundering Council, the National Bureau of Investigation and the National Prosecution Service.