House to investigate Philhealth corruption

THE House of Representatives will conduct its own inquiry into the  reported new irregularities and corrupt activities allegedly involving  officials and personnel of the state-owned Philippine Health Insurance  Corp. (Philhealth).

The House committee on public accounts chaired by Anakalusugan  party-list Rep. Mike Defensor will start the investigation this  Wednesday.

Invited to the first hearing are officials of Philhealth and the  Department of Health, and former Philhealth anti-fraud legal officer  Thorrsson Keith, who has resigned, claiming top agency officials are  involved in corruption.

Defensor said Keith, in his resignation letter, also claimed that  millions of overseas Filipino workers should not be made to pay for  Philhealth “spillages.”

“Mr. Keith should explain what these spillages are, what are the  instances of corruption in the state health insurance firm, and who  are the officials and personnel involved,” he said.

He said Philhealth has had its share of corruption issues in the past.

Defensor cited an August 2019 Commission on Audit (COA) report that  called out the agency for a suspicious surge in cases and  reimbursement claims of members from Rizal and Metro Manila for  pneumonia, urinary tract infection, acute gastroenteritis, sepsis, and other diseases.

He said tens of billions in “overpayments” were blamed on the  “all-case rates” or case package payment mechanism.

“The case-rate system, under which there is a fixed cost for the  treatment of certain diseases and for procedures, is really a loophole  that is resulting in billions of losses on the part of Philhealth. It  is not surprising that it maybe a source of corruption,” he said.

Defensor explained that under the system, Philhealth pays the hospital  the “case rate even if the cost incurred by a member is much, much  less.”

“For instance, the case package for mild pneumonia is about P44,000. A  hospital could declare that it treated a Philhealth member for  pneumonia even if he had only colds and fever,” he said.

He said there have been instances in the past where a simple eye  procedure was claimed as a cataract operation.

He said his proposal is for Philhealth to be billed the actual cost of  treatment or procedure, and for the case rates to be declared as cost  limits.

Defensor also urged Philhealth officials to watch for red flags like  numerous claims for payment or reimbursement for the same or similar  diseases or procedures, and involving the same doctors, clinics or  hospitals.

“This has happened with pneumonia, eye problems, and dialysis and  kidney ailments. They should have learned their lesson. It cannot  continue to happen, unless some officials and personnel are involved  in corruption,” he said.