Hospital chiefs called to PhilHealth inquiry

Mike Defensor

THE House committee on public accounts, chaired by Anakalusugan Rep. Mike Defensor, summoned the officials of at least 18 hospitals that are facing fraud cases in connection with the irregularities in the Philippine Health Insurance Corp. (PhilHealth).

Defensor ordered the attendance of the officials in the next virtual hearing set on Thursday in order to shed light on the alleged irregularities.

“Ipapatawag natin ang mga opisyal ng mga ospital na ito sa next hearing. Madami silang kaso, pinakamababa diyan ay may dalawang kaso, pero marami sa kanila have more than 10 cases,” Defensor said at the resumption of the hearing yesterday.

Supporting the move of Defensor, Cavite Rep. Elpidio Barzaga Jr. said he wanted to know if these hospitals were also given Internal Reimbursemet Mechanisms (IRM) by the PhilHealth.

“We should know how much PhilHealth funds were paid to them during the last three years. Also, we should ask them if they were given IRM,” Barzaga added.

Among the hospitals are Abra Provincial Hospital; Baguio General Hospital, Benguet General Hospital; Cagayan de Oro Maternity Children’s Hospital; Bontoc General Hospital; Butuan Doctors Hospital and College Inc; Divine World Hospital; Cuison Zabala Birthing Home; Holy Trinity Medical Clinic; Quezon City Eye Center; and United Doctors Hospital of Kidapawan Inc.

Earlier, Defensor disclosed that at least 51 healthcare institutions facing fraud cases were given IRMs by PhilHealth.

Defensor said the total amount of IRM release is P1.49 billion.

The 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.

Based on the documents, 4,664 fraud-related offenses of the 51 healthcare facilities were recorded from 2013 to 2020. 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.

Defensor, chairman of the House committee on public accounts, questioned PhilHealth officials over the issuance of IRM to hospitals accused of fraud. 

No ‘palakasan’ – Duque

Health Secretary Francisco Duque III on Tuesday faced the Senate Committee of the Whole and denied that a “palakasan” system is involved in the release of funds of the Philippine Health Insurance Corp (PhilHealth), saying they are not tolerating fraud and corruption.

During the Senate investigation, Duque denied any anomaly in the interim reimbursement mechanism (IRM).

“On the allegations of ‘palakasan’ system on the release of the IRM, we assure you there is none,” he said.

PhilHealth defines the IRM as “a special privilege for the provision of substantial aid to an eligible Health Care Institution (HCI) directly hit by fortuitous event with clear and apparent intent to continuously operate and/or rebuild the HCI in order to provide continuous health care services to adversely affected Filipinos.”

The IRM has since been suspended by PhilHealth, amid issues hounding the payment system.

“IRM is not specific only to the COVID-19 pandemic as it is based on the provisions of the National Health Insurance Act and the Universal Health Care,” Duque added.

“My commitment to safeguarding the sustainability of the fund is very personal and I would like to state for the record that I am zero tolerance for fraud and corruption,” he futher said.

Corruption charges

Senator Panfilo “Ping” Lacson said that Philippine Health Insurance Corp. (PhilHealth) president Ricardo Morales and the state insurer’s fund management chief will surely face several cases of corruption.

During the resumption of the investigation of the Senate Committee of the Whole into alleged PhilHealth anomalies, Lacson disputed the previous claim of PhilHealth Senior Vice President for Fund Management Sector Renato Limsiaco Jr. that he was not aware of the agency’s obligation as a withholding tax agent when releasing funds under the interim reimbursement mechanism (IRM).

“When I countered that advance payments are subject to withholding tax, he admitted that PhilHealth had in fact remitted P156 million to the BIR last August 3, and then claimed that he charged the amount to the Corporate Operational Budget of PhilHealth. Then, he followed up with another lie – that he didn’t know that it was an obligation under the law that he had to withhhold taxes. This w    as on August 11, Tuesday,” Lacson said in his opening statement.

The senator showed a memorandum issued by Morales and Limsiaco which indicated that the agency has already remitted two percent of the expanded withholding tax to the BIR.

“The memorandum was dated August 7 or four days after Limsiaco patently lied to the august committee,” said Lacson.

The senator also said Morales and Limsiaco ordered regional vice presidents to issue BIR Form 2307 to health care institutions (HCIs) which received IRM advance payments.

“Ang BIR Form 2307 ay iniisyu bilang katibayan na nakapagbayad na ng expanded withholding taxes ang isang ospital para sa kanilang IRM advance payment na tinanggap,” the senator further said.

“Kung susundan natin ang argumento ni SVP Limsiaco na wala pang buwis na nakokolekta sa mga ospital, hindi ba bukod sa pagsisinungaling, inutusan pa nila ni Gen Morales ang mga RVPs na mag-commit ng krimeng Falsification of Public Documents?” he added.

“In our foregoing inquiry about PhilHealth’s IRM, it may be a truism that when there is smoke, there is fire,” Lacson added.

“One of the contentions of the policy is that the determination of IRM funds for HCIs, its consequent approval, and fund releases, are very centralized. It follows that the preference and prioritization of which hospitals to receive the IRM funds remain at the discretion of the Central Office,” Lacson said.
With Marlon Purificacion