MANILA, Philippines — President Duterte has ordered a deeper probe into reports that some Philippine Health Insurance Corp. (PhilHealth) officials could be involved in the payment racket for “ghost” dialysis treatments.
While PhilHealth has already taken action on the matter, presidential spokesman Salvador Panelo said Duterte wants charges to be pursued against the erring officials.
PhilHealth officials have filed administrative complaints against those implicated in the fraud.?
Duterte directed the PhilHealth management to pursue criminal charges against those officials and employees who allowed, wittingly or unwittingly, such misuse of funds to take place for years.
The President has instructed PhilHealth to submit a detailed report on the irregularities.
“We will put a stop to this corruption and we will make sure that the law on universal health care is strictly enforced,” Panelo said.
Panelo reiterated that the Duterte administration is steadfast in its goal to eliminate corruption in all levels of the bureaucracy.
“All persons involved in the alleged fraud will be prosecuted and face accountability. They shall reap the harshest penalty imposed by law. Nothing can shield them from prosecution and punishment,” he said.
Malacañang expressed concern over the reported anomaly.
“The Palace views with deep concern the allegations of irregularities involving the Philippine Health Insurance Corp., particularly those with regard to the reported anomalies in connection with bogus kidney dialysis treatments,” he said.
Health Secretary Francisco Duque III yesterday warned all healthcare facilities and health professionals accredited with PhilHealth that they will lose their accreditation if they make fraudulent claims.
Duque said erring facilities and professionals “stand to lose much” if they engage in nefarious activities like padding their claims or seeking reimbursement for services they did not render.
“It will really be difficult for them. If they will risk it, for what? They should stop these irregularities, this criminal act. Otherwise, their accreditation will be revoked,” he noted.
The health chief assured the public that there are reforms being instituted to protect PhilHealth funds “but the outcomes of these reforms will not be felt immediately.”
“For now, it is enough to say that cases have been filed against erring facilities... This is a warning – they will not easily get away with it,” he added.
Refund
The Commission on Audit has called out the Lung Center of the Philippines to refund to the members of PhilHealth their Medicare benefits totalling P22.616 million.
“Verification of the PhilHealth Medicare Patients Refund account showed that the Lung Center of the Philippines (LCP) had total collections amounting to P28.058 million from PhilHealth from calendar years 2002 to 2018 based on the general ledger,” COA noted in its annual audit report on the LCP.
“However, it was noted that only 19 percent or P5.442 million was refunded to the concerned patient-members, leaving P22.616 million still to be refunded as of Dec. 31, 2018.”
The audit body pointed out that under PhilHealth Circular No. 42 dated Sept. 28, 2009, all accredited Institutional Health Care Providers (IHCPs) who have already been reimbursed of National Health Insurance Program (NHIP) benefit claims made on the patient-member’s accounts are required to refund the member-claimant within 60 days from receipt of the reimbursement from PhilHealth.
COA said the same circular also states in case the accredited IHCP fails to refund the member-claimants, or should the member-claimants or their representatives fail to claim the refund within 60 days, the same shall be returned to PhilHealth within 30 days from the lapse of the claiming period “without any need for a demand.”
“The inability to return the PhilHealth Medicare Patients Refund totalling P22.616 million is not only contrary to Paragraph B(1) of PhilHealth Circular No. 42, s. 2009, but likewise the concerned patient-members are deprived of the benefit,” the COA said.
The COA directed the LCP to “exert all efforts” to refund to PhilHealth members the amounts deducted from them.
“For the balance of P22.616 million not returned yet to concerned patient-members, exert all efforts to determine the possibility of making the necessary refund based on available records; otherwise, return the same to PhilHealth pursuant to paragraph B(2) of PhilHealth Circular No. 42, s. 2009,” COA said.
COA noted that during an exit conference with the audit team, the LCP management said it had already assigned personnel to review the amount booked under the PhilHealth Medicare Patients Refund account.
COA said the LCP management committed to reconcile the account by end of 2019 and “to notify the patients of the said refund.”
COA said the LCP promised to return the unrefunded amount to PhilHealth in case the patients could no longer be found or traced.
“As a rejoinder, the Audit Team acknowledged the [LCP] Management’s commitment to implement the audit recommendations and their full compliance thereof will be monitored in CY 2019,” the COA said. With Elizabeth Marcelo, Sheila Crisostomo