PhilHealth execs grilled over graft

August 05, 2020

THE House committee on public accounts, chaired by Anakalusugan Rep. Mike Defensor, grilled officials of the Philippine Health Insurance Corp. (PhilHealth) on several issues particularly corruption.

Defensor specifically cited the so-called case rate policy in PhilHealth which he said is the root of all corruption in the agency.

On the other hand, Marikina Rep. Stella Quimbo questioned PhilHealth’s P45-billion projection for claims related to coronavirus disease (COVID-19) pandemic.

During the hearing Defensor pointed out that the case rate set-up has resulted in the loss of billions of PhilHealth funds due to overpayment.

The case rate refers to the fixed amount that PhilHealth will reimburse for a specific illness, which will cover the fees of health care professionals and the use of hospital facilities.

“Yan ulit ang magiging ugat ng problema ng PhilHealth at diyan magkakaroon ulit ng butas ng issue ng corruption ang PhilHealth,” Defensor said.

“We would request na magkaroon na ng malinaw na polisiya. Na sa ilalim ng adminsitrasyon ni Pangulong Duterte ay itigil na ang all case rate policy na nagiging ugat ng korapsyon sa PhilHealth,” he added.

The case rate for pneumonia amounts to P15,000; P6,000 for food poisoning or acute gastroenteritis; and P7,000 for urinary tract infection (UTI).

PhilHealth pays an average of P700,000 annually in claims for the past five years for pneumonia cases; P350,000 yearly for cases of acute gastroenteritis; and P300,000 for UTI cases

Such policy is  prone to corruption, Defensor stressed.

“Yun pong all case rate policy na binabanggit ko sa inyo kahit na anong gawin niyong computerization, nako-computerize na ho ang corruption diyan sa loob ng PhilHealth,” the lawmaker told PhilHealth president and CEO Ricardo Morales.