PhilHealth anomalies rooted in lack of validation system, slow legal team: PACC

Katrina Domingo, ABS-CBN News

Posted at Aug 11 2020 12:01 PM

PhilHealth anomalies rooted in lack of validation system, slow legal team: PACC 1
People crowd outside a PhilHealth branch in Quezon City on August 3, 2020, last day of the General Community Quarantine (GCQ) before Metro Manila reverted to Modified Enhanced Community Quarantine (MECQ). Fernando G. Sepe Jr., ABS-CBN News/file photo

MANILA - Multibillion-peso anomalies at the Philippine Health Insurance Corp (PhilHealth) stem from the agency's lack of a system that would validate claims and the slow action of its legal department against fraud, the Presidential Anti-Corruption Commission (PACC) said Tuesday.

Between P2 billion and P3 billion of PhilHealth funds are exposed to corruption weekly because some employees can "manipulate" transactions, PACC Commissioner Greco Belgica said during a Senate investigation.

"Ang IT system na ginagamit ng PhilHealth has no validation mechanism kaya nama-manipulate ng mga empleyado at ospital," he said.

(The IT system that PhilHealth uses has no validation mechanism so some employees and hospitals can manipulate it.)

"Dahil walang validation mechanism, bayad lang ng bayad ang PhilHealth na parang tanga sa mga ospital na ginagago ang mga tao," he said.

(Since there is no validation mechanism, PhilHealth - like a fool - keeps on paying hospitals that have been duping the people.)

Some PhilHealth employees would collude with hospitals to double the amount of insurance claims, Belgica said, citing the findings from the PACC's investigation.

Other fraudulent schemes in the state-run insurance agency are payments to ghost patients, use of fake receipts, and the collection of kickbacks from hospitals, he said.

Instead of auditing all claims, the checking of transactions is only done at random, the Commissioner said.

"Sa IT, walang malinaw na system... Fragmented, hindi transparent... at sila-sila lang ang may alam kung ano ang naroon," he said.
(The IT has no clear system... It is fragmented and it is not transparent... Only those in the agency can understand it.)


The state-run insurance firm's legal department has failed to police the system, and may have even worsened corruption in the agency, Belgica said.

The approval of claims "experiences a bottleneck due to poor system management" and the lengthy process in the legal department creates more opportunities for irregularities.

Under the PhilHealth's system, complaints have to be filed in regional offices. The legal services team of each region would forward the complaint to the Fact Finding Investigation and Enforcement Department before it reaches the Prosecution Department.

After issue goes through the 3 offices, only then will an arbitration group tackle the dispute, which will be submitted to the PhilHealth board for approval.

"This is the very problem why there is almost no case filed by PhilHealth against erring hospitals," Belgica said.

"Sa haba ng systema na 'yan ang dami nang paraan para harangin mo ang mga kaso," he said, noting that the insurance firm has yet to resolve some 200 cases in one hospital alone.

(With the length of that process, there are many opportunities where you can block a case.)


Contrary to the assertion of PhilHealth President Ricardo Morales and other officials, the agency does not need to have P2 billion to fortify its IT system against corruption, Belgica said.

"Hindi kailangan ng PhilHealth ng P2-billion funding kung talagang gusto nila ng solusyon sa problema," he said.

(The PhilHealth does not need P2 billion if they really want to solve the problem.)

"Maraming IT companies na ang nag-offer ng solution at no cost to government," he said, noting that the insurance agency did not take any of those offers.

(A lot of IT companies have offered solutions at no cost to the government.)

The national government needs to cleanse the entire PhilHealth system from the head down to the roots, Belgica said.

"Paulit-ulit ang imbestigasyon pero walang nababago... kailangan lahat hanggang baba makasuhan, maparusahan," he said.

(The investigations are done over and over but nothing changes... we need to file cases up to ground-level employees to hold them accountable.)

The PACC earlier said that it would file criminal charges against 13 PhilHealth officials, while 23 others would face administrative cases.

Belgica did not disclose which officials would be held liable over "systemic corruption" in the agency, but ended his statement by saying: "'Pag may nakawan na nangyari at hindi ka umimik, ang tawag sa iyo ay kasabwat."

(If there is corruption and you did not speak out, you are a cohort.)