The beleaguered Philippine Health Insurance Corp. (PhilHealth) assured members Saturday that health insurance benefits will continue in the wake of concerns coming from beneficiaries who have expressed apprehension over the corruption allegations now hounding the agency.
The state-run health insurer made the assurance even as new allegations surfaced involving not only bogus dialysis claims but other fraudulent schemes that benefitted some officials and politicians.
“PhilHealth assures the public that members can continue to avail of their health insurance benefits as normal through the PhilHealth accredited Healthcare facilities especially during this time of the pandemic,” the agency assured amid the recent suspension of several senior officers and the ongoing Senate and Congressional hearings.
PhilHealth, however, clarified that the preventive suspension orders recently issued by the Ombudsman to some of its current and former officers is not in any way connected with the on-going hearings in both houses of Congress regarding the above-mentioned alleged corruption.
The Ombudsman order stemmed from the complaints of “grave misconduct, oppression and conduct prejudicial to the best interest of the service” filed by some regional officers in connection with the administrative cases filed against them between 2017 to 2019.
“Amidst all of these, PhilHealth reiterates its commitment to fully cooperate with all the investigating authorities,” the agency said.
A template case
Regional vice presidents (RVP) of the PhilHealth and conniving hospitals allegedly benefitted from bogus claims for pneumonia patients, high-ranking sources told the Daily Tribune.
The scheme mirrors the controversial WellMed scam uncovered last year where names of dead kidney dialysis patients have been used to pocket funds from the contributions of PhilHealth members.
The matter became a subject of tedious congressional hearings and led to the firing of former PhilHealth chief Roy Ferrer.
Sources alleged that PhilHealth protocols used to be lax, where hospitals can easily tag usual coughs and colds as pneumonia cases to get additional claims from the state insurer.
And the RVP, who serve as a bridge between the corporation and hospitals, allegedly took advantage of the matter, too.
“RVP are the ones paying the hospitals, they check the claims. If ever the hospitals make false claims, RVP will be the first ones to know,” said Tribune sources who requested anonymity.
“The most common fraudulent diagnosis is pneumonia so when we entered the agency we saw that PhilHealth was not advising the hospitals to submit any documents that would prove that it is pneumonia, AGE (acute gastroenteritis) and UTI (urinary tract infection),” one source added.
The insider also claimed that when pneumonia patients were flagged, hospitals renamed it to other diseases.
“The claims for pneumonia at that time decreased but the problem was that the fraudsters were really wise. The claims for other diseases not monitored by PhilHealth later increased,” the insider said.
The sources also alleged that these regional officials in Luzon, Visayas and Mindanao blocked the “rotation” among employees to stay in their posts.
There could probably be a “connivance” between hospitals and these RVP — some of whom stayed in their posts for almost 20 years — sources said.
They have been defying the Civil Service Commission (CSC) which provides that government employees should be rotated to avoid familiarity and, subsequently, corruption.
It was a rule ignored by officials even before President Rodrigo Duterte’s term, according to sources.
The most number of “fraudulent claims” reported were flagged in hospitals in regions IX, X, XI, XII, CARAGA and the Autonomous Region in Muslim Mindanao (ARMM).
Other regions from Luzon and Visayas also had “fraudulent claims,” according to the source.
Part of Mafia
During the congressional probes at the height of the WellMed scam, Ferrer tagged some RVP of these regions as part of a supposed “mafia” who wielded high influence in the agency.
They were Paolo Johan Perez, RVP of PhilHealth Regional Office 4B; Khaliquzzaman Macabato, RVP of PhilHealth Regional Office ARMM; Valerie Anne Hollero, Assistant Corporate Secretary; Dennis Adre, RVP of PhilHealth Regional Office XII; Masiding Alonto Jr., RVP of PhilHealth Regional Office Region X; Jelbert Galicto, RVP of PhilHealth Regional Office CARAGA; and William Chavez, RVP of PhilHealth Regional Office Region VII.
During his time as acting PhilHealth President, about 7,000 administrative cases involving health care providers and 100 cases involving PhilHealth executives were unearthed.
The source said the cases were pending before PhilHealth’s Arbitration Office for five to 10 years.
“We found out that there were approximately more than 7,000 administrative cases involving health care providers pending for more than 10 years while about a hundred cases involving administrative disciplinary cases are still pending or stalled for about five years.”
The source said PhilHealth under the leadership of Ferrer tried to resolve these cases when he was still in the agency.
But another insider said that numerous cases remain pending before the PhilHealth Arbitration Office to date, due to the defective legal process within the department.
He said the pending cases before the arbitration panel take years to be resolved noting that these processes also become one of the sources of corruption.
RVP protected by ‘influential officials’
“The group of regional vice presidents are really protected by people who are powerful and influential officials in the government so that’s why they can hide their cases for so long a time,” another source said, noting that the hundreds of administrative cases have not been acted upon for more than 15 years.
The source further said that at present the alleged group has already extended their clout within the agency.
In a related development, Justice Secretary Menardo Guevarra yesterday said agents of the National Bureau of Investigation (NBI) who went to inspect PhilHealth Region 1 office discovered rain soaked computer and equipment due to water leak.
“The NBI field operatives immediately inspected the subject PhilHealth Regional office. It appears that many of the records have been saved but the computer hardware and equipment were exposed to rain water leaks,” said Guevarra in a message.
He said the NBI agents also noticed that the rain gutters of the building were clogged and saw a piece of cloth stuck in the opening of the drain pipe.
Asked to extent of the damage to the computers the justice chief said, “We will know the extent of the damage and its impact on the ongoing investigations once the computer system is run again.”
with Neil Alcober
and Alvin Murcia