Lawmaker questions alleged PhilHealth policy letting probable COVID patients claim P786k

ABS-CBN News

Posted at Aug 22 2020 07:54 PM

MANILA - Marikina City Rep. Stella Quimbo on Saturday questioned a policy being enforced by the Philippine Health Insurance Corp. (PhilHealth) allegedly granting P786,000 each to "probable" COVID-19 cases.

Quimbo, who took part in the House joint panel inquiry into the alleged irregularities at PhilHealth, said this was just one of the various schemes that resulted to the loss of P15 billion in the state insurer’s funds.

"Mayroon silang polisiya na puwede kang mag-claim ng COVID case rates kahit na ikaw ay probable COVID patient lamang," Quimbo said in an interview on Teleradyo.

"Ibig sabihin, hindi ka confirmed pero puwede kang mag-charge ng up to P786,000, which is the case rate for a COVID critical patient.

"Paanong mangyayari 'yun? Because at the time of payment malalaman na ng ospital kung confirmed COVID-19 case ka o hindi."

Another scheme that led to the losses is the state insurer's reimbursement mechanism (IRM) funds that allegedly let health-care institutions to freely use them for any purpose.

"Maganda naman ang layunin. Dahil may delay ang payments, in-authorize silang gamitin ang IRMs," said Quimbo. "Pero ang nangyari ang laki-laki ng in-advance nila, naglabas siya ng P14.9 billion."

"Pero base sa pag-compute ko kung anong pangangailangan nila... ang computation ko is P3.3 billion lang ang kailangan, (pero) ang in-advance nila is P14.9 billion."

Quimbo said the schemes were deeply rooted within PhilHealth since it required the collusion of various sectors.

"Kumplikado ang modus kasi kailangan ng collusion o pagkukunstaba. Sa central office, may regional ka pa, may ospital ka pa at mayroon ka pong pasyente," said Quimbo, who proposed to privatize PhilHealth.

In response to allegations, PhilHealth president and CEO Ricardo Morales had denied coddling an alleged "mafia" in the agency.

"Ginagawa ko lang po ang tingin kong tama pero itinatanggi ko ho na ako ay coddler ng sindikato. Hindi ko ho kinikilala na mayroon hong sindikato sa loob. Mayroon hong gumagawa ng katiwalian sa loob, pero hindi ko ho alam kung ito ho ay sindikato o hindi," he said in the first Senate hearing on Aug. 4.

Several PhilHealth officials will also press charges against lawyer Thorrsson Montes Keith, who alleged they siphoned off billions from the company's coffers.

"Meron kasi siyang pinirmahan dito na confidentiality clause and he revealed inside information so we will see what we can do about that," Morales had said.

Keith is among 3 PhilHealth officers granted by Senate legislative immunity to speak more freely on alleged corruption schemes within the state-run health insurance company.