Three Mindanao facilities which Philippine Health Insurance Corp. (PhilHealth) president Dante Gierran said were in the vortex of irregularities that threw the besieged agency into financial disarray have been slapped various charges for the first time since the alleged problems erupted.
Gierran said the facilities in Zamboanga del Norte, Koronadal in South Cotabato and Davao del Norte all received the complaints of the National Bureau of Investigation (NBI) a week ago.
“The cases struck at the very core of the alleged fraud committed against PhilHealth involving upcasing, upcoding, upbilling and the rest,” he said in a television interview.
The charges were on top of the cases initially filed against Philhealth officers including Gierran’s predecessor, former CEO Ricardo Morales for allegedly being part of crooked schemes.
He noted that PhilHealth still have about 7,500 other backlog cases in the central office still needing to be settled.
For months, PhilHealth has been under fire from lawmakers and the public due to alleged ghost or overpriced claims.
Also schemes such as upcasing and upcoding that involved a patient being given a fake diagnosis to collect higher health insurance payments were uncovered on some partner institutions of PhilHealth.
Whistleblower and former PhilHealth anti-fraud legal officer Atty. Keith Thorsson said that top officials were part of a “mafia” that exploited the Interim Reimbursement Mechanism (IRM) that allowed hospitals to file claims with the agency as a strategy to siphon off P15 billion worth of funds.
The IRM was designed to keep hospitals afloat as infection cases rise. Issues were also previously raised behind the Mindanao institutions’ overpriced information technology (IT) equipment and other COVID-19 testing packages which lawmakers likewise found questionable.
Ex-NBI chief in spotlight
In August, Gierran was appointed by President Rodrigo Duterte to replace Morales in leading PhilHealth and gave him until the end of this year to clean up the agency.
He acknowledged that it is a challenging task but said he will do his best to at least create a ‘dent’ on the fraud syndicate.
“That’s a very hard job. You know, this reported fraud existed for a long time and cost something like P150 billion according to the report of the CoA (Commission on Audit),” he said.
“If I can only create a dent on this alleged corruption in PhilHealth, then I will be happy and go back to my hometown happy,” he added.
PhilHealth has been under fire in recent months after a whistleblower claimed that key officials behind a so-called mafia pocketed P15 billion from the agency through various illegal schemes.
Last year, PhilHealth was also embroiled in irregular claims from dialysis centers.