'Claims without validation': PACC says 36 PhilHealth execs linked to overpayments


Posted at Aug 05 2020 11:34 AM | Updated as of Aug 05 2020 06:09 PM

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Like paying at a restaurant without checking the bill. 

This is how Commissioner Greco Belgica of the Presidential Anti-Corruption Commission described a loophole in the Philippine Health Insurance Corp. (PhilHealth) that allows medical facilities to pad their claims to the state-owned insurance firm. 

Speaking to ABS-CBN's TeleRadyo, Belgica said PACC has identified at least 36 officials that should be fired or face charges for alleged involvement in the overpayments scam. A partial report on the PACC findings has been submitted to the Office of the President last Monday.

"Per region ang transaction diyan sa PhilHealth, doon naman ang yarian sa corruption dahil operational...Wala ho kaming pinili. Mataas, mababa, nandoon lahat iyon," he said.

In the interview, Belgica said PhilHealth has lost at least P154 billion due to overpayments since 2013. One reason for the overpayments, he said, is that PhilHealth has no system to check the validity of the claims. 

"Problema ho talaga diyan fundamentally sa IT dahil 'yung IT nila has no way of validating information na pinapadala sa kanila ng mga ospital and this has been going on for many, many years," he said.

"Many people already found out how to take advantage of the situation kaya pag nagpadala kunwari ospital nagpadala ng fraudulent claims like upcasing, sipon ginagawang pneumonia, 'yung mga ganun po ba, so tumataas 'yung presyo. Ito naman PhilHealth parang ATM, bayad lang ng bayad...Para tayong siningil sa restaurant pero hindi natin tinignan yung [bill]."

Former PhilHealth Anti-Fraud Legal Officer Atty. Thorsson Montes Keith earlier revealed that around P15 billion in public funds had been pocketed by so-called "mafia" in the agency.

Keith did not mention particular officials, but noted that overseas Filipino workers are being unfairly charged as they also shoulder the supposed share of employers.

"Naniniwala po ako na ang dahilan kung bakit hindi natatapos ang korapsyon sa PhilHealth at naging kultura na po ito ay dahil sa pagtatalaga ng mga sindikato o mafia ng kanilang kasamahan, kasabwat o kapwa sindikato sa mga matataas na posisyon na nakakatulong sa kanilang ilegal operasyon," he said in a Senate inquiry. 

(I believe that the culture of corruption continues in PhilHealth because the mafia or syndicates in the agency continue to appoint their members in high positions, which helps their illegal operations.)

Keith has also claimed that he was ordered by PhilHealth chief Ricardo Morales to approach Belgica to "massage" the issue on supposedly overpriced COVID-19 testing kits, an order that he rejected. 

Asked about the issue, Belgica said: "Hindi puwede ang hilutan sa PACC lalo na sa opisina ko. Anyone who attempts that, pahuhuli ko...If that would have happened, baka may nakulong na po."