The House of Representatives will conduct on Wednesday its own inquiry into the reported new irregularities and corrupt activities allegedly involving officials and personnel of the state-owned Philippine Health Insurance Corp. (Philhealth), a House official said.
Rep. Mike Defensor of party-list group Anakalusugan, chair of the committee on public accounts, said Monday his committee would start the investigation.
Invited to the first hearing are officials of Philhealth and the Department of Health, and former Philhealth anti-fraud legal officer Thorrsson Keith, who has resigned, claiming top agency officials are involved in corruption.
Defensor said Keith, in his resignation letter, also claimed that millions of overseas Filipino workers should not be made to pay for Philhealth “spillages.”
“Mr. Keith should explain what these spillages are, what are the instances of corruption in the state health insurance firm, and who are the officials and personnel involved,” he said.
He said Philhealth had had its share of corruption issues in the past.
Defensor cited an August 2019 Commission on Audit report that called out the agency for a suspicious surge in cases and reimbursement claims of members from Rizal and Metro Manila for pneumonia, urinary tract infection, acute gastroenteritis, sepsis, and other diseases.
He said tens of billions in “overpayments” were blamed on the “all-case rates” or case package payment mechanism.
“The case-rate system, under which there is a fixed cost for the treatment of certain diseases and for procedures, is really a loophole that is resulting in billions of losses on the part of Philhealth. It is not surprising that it maybe a source of corruption,” he said.
Defensor explained that under the system, Philhealth would pay the hospital the case rate "even if the cost incurred by a member is much, much less.”
“For instance, the case package for mild pneumonia is about P44,000. A hospital could declare that it treated a Philhealth member for pneumonia even if he had only colds and fever,” he said.
He said there had been instances in the past where a simple eye procedure was claimed as a cataract operation.
He said his proposal was for Philhealth to be billed the actual cost of treatment or procedure, and for the case rates to be declared as cost limits.
Defensor also urged Philhealth officials to watch for red flags like numerous claims for payment or reimbursement for the same or similar diseases or procedures, and involving the same doctors, clinics or hospitals.
“This has happened with pneumonia, eye problems, and dialysis and kidney ailments. They should have learned their lesson. It cannot continue to happen, unless some officials and personnel are involved in corruption,” he said.