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7 in PhilHealth ‘mafia’ named

A former Philippine Health Insurance Corp. board member-turned-whistleblower on Wednesday identified seven officials in the so-called PhilHealth mafia that ensured there were no review of rates and overpayments, and who manipulated the processing of claims for their own benefit.

7 in PhilHealth ‘mafia’ named
HEALTH ISSUES. Health Secretary Francisco Duque III (left), beside Rep. Janette Garin, former Health secretary, answers questions from Senator Richard Gordon, chairman, Senate Blue Ribbon Committee (far right) and Senator Christopher Go, chairman, Senate Committee on Health, during the Senate public hearing Wednesday on the privileged speech of Senator Panfilo Lacson titled ‘PhilWealth and Department of Wealth and Fraudulent Medical Claims to the Philippine Health Insurance.’ Lino Santos
During the Senate Blue Ribbon committee’s hearing into the alleged fraud and corruption within PhillHealth, former board member Roberto Salvador named the seven officials as: Paolo Johan Perez, Regional Vice President (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.

The seven officials, who have been suspended, denied any wrongdoing.

Hollero said it was their group, in fact, that reported fraud and testified in an August 2017 hearing on good governance and public accountability in the House.

But Salvador told the panel chaired by Senator Richard Gordon that the word “mafia” refers to a closed group of people in a particular field having control or influence.

“They have influence. What they were doing, they were destroying the present administration if they will be touched from their current positions,” Salvador said.

Gordon described as “ludicrous” the admission of PhilHealth president Ricardo Morales that the state insurance company would need “whistleblowers” to unearth fraudulent transactions in the agency.

In the hearing, Senate Minority Leader Franklin Drilon pressed Morales on where anomalies within PhilHealth take place.

“Maybe we have a general idea of where the anomalies take place? We want to know where corruption happens in PhilHealth and who is responsible. Without naming names first. Is it the claims? Is it the service provider?” Drilon said in a mix of English and Filipino.

Morales merely said anomalies “can happen at any point in the process.”

“PhilHealth is a very large and complicated organization, we handle 10-million claims a month… Some of these have to be handled manually because they cannot be fed automatically into the system,” Morales said.

At the hearing, PhilHealth officials admitted that the agency lost an estimated P153 billion in overpayments and possible fraud.

Senator Risa Hontiveros said there was a need to review PhilHealth’s case-based payment system, which is prone to abuse.

“Serious allegations of fraud and financial mismanagement erode public trust in our health care institutions and endanger the lives of people by denying them the medical treatment they need,” she said. “We need to have more stringent procedures to protect the public health sector against bad and abusive practices.”

Senator Juan Edgardo Angara, meanwhile, said PhilHealth should beef up its anti-fraud system.

“Don’t get me wrong, we’re not talking about instituting a spy system within PhilHealth, but rather a system that will be able to spotanomalies efficiently,” he said.

He said anti-fraud is a necessary expense that pays for itself because it deters costly fraud that would leave a hole in PhilHealth’s pocket.

PhilHealth should have in place a strong IT system that is capable of coming up with a more transparent billing process, Angara said.

Senator Lito Lapid, on the other hand, said he has filed a bill increasing the penalty for fraudulent claims for benefits from PhilHealth, the Social Security System and the Pag-IBIG Fund.

Under his bill, the penalty imposable for any member, real estate developer, health care provider or person, who causes the filing of a false or fraudulent claim for benefits or entitlements, would be imprisonment for 12 years and a day up to 20 years, or from 20 years and a day to 40 years.

If the fraudulent claim is committed by a syndicate consisting of five or more persons, the penalty will be life imprisonment.

READ: PhilHealth clarifies issues raised by COA on ‘lapses’

Topics: Philippine Health Insurance Corp. , Paolo Johan Perez , Roberto Salvador
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