Universal Health Care law to solve fraudulent claims, says health advocate

ABS-CBN News

Posted at Jun 13 2019 01:13 PM

MANILA - Health advocate Dr. Tony Leachon on Thursday said the implementation of the Universal Health Care Law would help solve fraudulent claims that has been an issue at the Philippine Health Insurance Corp. (PhilHealth).

Leachon said on ANC's Headstart that the problem with the country's state health insurance agency is organizational.

"There must be right now a good leadership team that can actually carry out the promise and the banner program of this administration for the next generation," said Leachon.

 

He made the comments as authorities pursued accountability of those behind the alleged ghost dialysis treatment scandal involving Quezon City clinic WellMed. 

The clinic allegedly made PhilHealth claims on behalf of patients who were already dead. 

Leachon also disagreed with recommendations to suspend the Universal Health Care law.

"Ang dali naman niyan (that's too easy), you have to choose the right leaders, the processes are in place. The Universal Health Care is there, the penal provisions [are] there," he said.

He explained that the new law's penal provisions have more teeth now than before, which allowed a “kid glove treatment” of violators.

"The penal provisions malupit (are strict) in Sec. 38 of the Universal Health Care law. We recommended in the board P200,000 per case and six months to six years imprisonment of everybody involved kasi it’s a group crime," he said.

The new law, he said, also specifically sets the criteria for the leaders of the agency.

"The main problem at PhilHealth is organizational. you have the board na nagmeet (that meets) every 15 days. I think it should be more. Dapat (It should be) I think weekly so that you can follow up," he said. 

The former PhilHealth independent director added that reforms should also include an external human resources agency to tap the right people for the organization aligned with the heath care law's requirements and an independent auditor to give a "helicopter view of the situation."

"Ang problema with the COA (Commission on Audit), post audit siya, tapos na (The problem with the COA, it's post-audit, [the act is] done)," he said.

He pointed out the need to hire private auditors for a certain period to guide the audit system while implementing the new law.

"If you want to be a Canadian health care system na wala kang babayaran ni singkong duling (where you do not pay a penny), then you need to invest now on fraud and corruption mitigation and control," he said. 

Leachon said the new law would strengthen primary care services benefiting especially the poor who lack money for check-ups and medicine.

"Primary care system is the way to do it. Libre ang check-up, libre and lab, libre ang medication so uuwi ka na hindi ka nairerefer kaagad (Free check-up, free laboratory test, free medication so you go home immediately without the need for referral)," he said.

Leachon described the health care law, signed by the President in February, as "the greatest legislation in our lifetime."

He said the purpose of the law is to reduce out-of-pocket expenses by increasing the case rates and benefits under PhilHealth. 

"Eventually, the dream is zero percent ang babayaran ng Pilipino (Filipinos will pay zero percent) like the Canadian healthcare system. That's the dream," he said.