PhilHealth is gravely sick

By Modesto P. Sa-onoy

An official of the Philippine Health Insurance Corp. (PhilHealth) told the Senators last Tuesday that the state-run medical insurer could reach the end of its actuarial life next year and collapse in 2022 because member contributions have dropped as a result of the COVID-19 pandemic, while benefit pay-outs are increasing for the same reason.

Testifying before the Senate, which is investigating alleged anomalies at the agency, PhilHealth Senior Vice President Nerissa Santiago told the senators that PhilHealth would incur P90 billion and P147 billion in operating losses in 2020 and 2021, respectively due to the “double impact” of the COVID-19 pandemic.

Another official, the anti-fraud officer Thorrsson Montes Keith who resigned after his allegations of anomalies in PhilHealth said the government was losing about P15 billion due to corruption that he labeled as “the crime of the year.”

He revealed the existence of a “syndicate-like” implementation of the “interim reimbursement mechanism and the procurement of overpriced information and communication technology equipment” as venues for corruption.

Keith who raised the alarm over corruption at PhilHealth, claimed that “the reason corruption doesn’t end in PhilHealth, which has become a culture already is due to the appointment, or the syndicate or mafia that has been put in place, of their peers, cohorts or fellow syndicate members in the executive department, which helps them in their illegal operations.” He believes the syndicate in PhilHealth planned to take money from overseas Filipino workers to replace the money they have already spent or stolen.

These are serious accusations but suspicions about corruption in PhilHealth had been raised before, however, nothing had been done except changing the officials. And so the bleeding of PhilHealth continues and now reaching into billions and its demise.

Earlier reports spoke of double-billing by cohort hospitals and by Dialysis Centers that have mushroomed all over the country. While the opening of more of these centers have helped patients as the fees had gone down, they also spawned corruption. This is a case of demonics in governments who prey on people.

So like the legendary Dracula, these officials suck the blood out of the people’s money to sustain their pleasures.

The pandemic which has everybody in the state of fear is another opportunity for these avaricious officials. While we see the pandemic as a disaster for most, these corrupt officials see the crisis as another opportunity to suck out the funds of PhilHealth believing that nobody is looking as everybody is focused on how to survive.

Sen. Francis Tolentino disclosed at the Senate hearing that some hospitals had been defrauding PhilHealth by collecting benefit claims for COVID-19 cases even if the patients were admitted for other ailments.

He reported that a hospital in Carmen town, Cebu, treated a stabbing victim but declared it a COVID-19 case.

They call this “fake COVID-19” cases. The victim was immediately cremated, but he tested negative (for COVID-19), Tolentino said. He cited another case of an individual injured in a motorcycle accident but listed as a COVID-19 case.

These are examples of how avaricious people use the pandemic for profit. The hospital cases are unthinkable. We trust the hospitals as institutions established primarily to help. The name “hospital” originated as institutions established by monks to help. Now the hospitals have become no different from business establishments organized for profit for exploiting the misery of others.

Senate Minority Leader Franklin Drilon said that “controversies continue to haunt PhilHealth because it does not follow simple auditing rules. We are in this mess because of Philhealth’s non-compliance with rules, including a simple COA rule.” He accused Philhealth of “disregard of all the rules designed to protect public funds as the cause of the illness of the agency.”

 

Drilon was referring to the Commission on Audit rule that no additional cash advances shall be allowed to any official or employee unless the previous cash advances given to him are first settled or a proper accounting has been made.

Drilon lamented that nothing has changed in PhilHealth since the Senate conducted an investigation on allegations of fraudulent claims, overpayments, and ghost dialysis payments last year. Now there was “overpricing of PhilHealth COVID-19 testing kits.” The investigation forced PhilHealth to bring down the cost from P8,150 to P3,409.

However, Philhealth did not learn but continued to buy at overprice and the bleeding continues. It needs extreme sanctions.