MANILA - Senate Majority Leader Juan Miguel Zubiri said Wednesday a scheme in the legal framework of PhilHealth allows fraud to thrive in the state insurance firm.
Zubiri said the agency does not enforce orders from the Supreme Court and Court of Appeals to PhilHealth to implement its rulings on cases the agency has won against fraudulent health care institutions.
"There’s also a racket within the legal framework of PhilHealth," he told ANC's Headstart.
"This is the problem, nobody gets caught...This is the one that really makes it difficult to get rid of corruption."
Zubiri cited the case of a hospital in Cebu City whose accreditation was supposed to be suspended for 3 months, which would have led to at least P60-million loss in claims, but it was fined "a mere P100,000."
"So, tuloy ang ligaya. That’s why, madaming nagalit," he said.
He added that many officials who come up with the fraudulent schemes were "only slapped on the wrist by a mere case of misconduct" and many of these cases were dismissed.
"This is the reason the rank and file of PhilHealth is so demoralized because... there were so many cases already filed and nothing happened," he said.
Aside from PhilHealth's issue in its legal framework, Zubiri also cited the agency's internal reimbursement mechanism (IRM), alleged overpriced items in its information systems budget, non-existent and ghost patients, and a "rebate" scheme.
Under the IRM, PhilHealth "parked" its funds to "favored" hospitals, according to Zubiri.
"That was proven by Commission on Audit yesterday. It’s highly irregular. Imagine, [President and CEO] (Ricardo) Morales said this is our way of parking the funds in these hospitals? We don’t do that with government funds," he said.
"PhilHealth is supposed to be paying claims, bills in hospitals, medicine used by poor people. It comes out, they have their own pork barrel system with the IRM, giving out money left and right to a favored few, and it’s a palakasan system."
As for non-existent and ghost patients, Zubiri cited that an 18-bed infirmary in Davao del Sur was paid P18 million in 2014. He also said some hospitals allegedly paid people P1,000 each to pretend as patients "to claim for more serious ailments."
A certain Pamela del Rosario and her parents were allegedly used by a hospital in Ilocos region as ghost patients to claim P1.7 million, Zubiri said.
Meantime, under the "rebate" scheme, Zubiri cited the experience of a Dr. David Gosengfiao of the Pacific Eye Institute who allegedly admitted in a 2016 PhilHealth board meeting that he had been asked to shell out P7.3 million so his clinic could reimburse claims amounting to P73 million for cataract removal surgeries.