PhilHealth suspends IRM implementation

MANILA, Philippines — The Philippine Health Insurance Corp. (PhilHealth) has suspended the implementation of the controversial Interim Reimbursement Mechanism (IRM) amid congressional inquiry into alleged anomalies in the agency.

PhilHealth announced the suspension of IRM in a message posted on its official Twitter account last night.

According to the state insurer, the suspension will allow it to “review and resolve” issues arising from the congressional inquiry.

PhilHealth vowed to find ways to make the IRM more responsive to the needs of healthcare facilities affected by the COVID-19 pandemic.

Lawmakers have started a probe on the alleged irregularities in the IRM, which was identified as the main source of corruption in the agency.

IRM funds are given to hospitals to give them sufficient liquidity for health crisis response, especially during the COVID-19 pandemic.

The agency’s resigned anti-fraud legal officer Thorrsson Montes Keith accused PhilHealth president and CEO Ricardo Morales of being a “coddler or (who) may have become the new leader of a syndicate in PhilHealth” for allowing the implementation of IRM.

Resident auditors have also linked one of its senior executives and a “former acting president and CEO” to the anomalous release of a “cash bonanza” from a P30-billion financial package for hospitals treating COVID-19 patients.

PhilHealth had assured patients of continuous and better access to needed healthcare services after review of the IRM.

Earlier, Morales defended the adoption of IRM.

Morales said PhilHealth was prompted to implement IRM in response to the COVID pandemic, which requires extraordinary measures.

He maintained that all transactions of IRM are aboveboard and within the guidelines set by the corporation.

Presidential spokesman Harry Roque said PhilHealth officials should be placed under preventive suspension to preserve any evidence. But he clarified that he was speaking on his personal capacity, not as Palace spokesman.

“I am urging the task force of (justice secretary) Meynard (Guevarra). The crooks have been there for so long and since there is a lot of evidence we have to protect, they should be placed under preventive suspension tomorrow,” Roque told radio dzBB.

“I would bar senior executives from entering the building and put them on preventive suspension right away, otherwise we won’t have any evidence against them,” he added.

Roque said until now, he still does not have documents to convict WellMed for malversation of public funds. Wellmed was tagged in the “ghost” dialysis controversy.

“It’s just one case. How about the bigger cases?” he said.

Roque previously said Duterte would wait for the advice of the task force before making a decision on the issues hounding PhilHealth. The President has vowed to put in jail officials of the health insurer who are involved in corruption.

Sen. Panfilo Lacson said Health Secretary Francisco Duque III would be grilled on the alleged corruption, being the incumbent ex-officio chairman of PhilHealth, once the Cabinet official attends the public hearing of the Senate committee of the whole on Tuesday.

Lacson questioned the silence of Duque in so many unanswered questions involving highly questionable transactions by PhilHealth.

The anomalies were exposed after a reported shouting match among officials during a board meeting that Duque attended.

Lacson enumerated the transactions as the procurement of information technology (IT) equipment, IRM funds distribution and manipulation of the agency’s financial statements which the Commission on Audit (COA) has red-flagged.

Sen. Sherwin Gatchalian expressed support for the call for the immediate preventive suspension of some PhilHealth officials to ensure a thorough investigation into the alleged questionable transactions.

Gatchalian agreed with Lacson that Duque should have done something to prevent corrupt activities in PhilHealth.

Gatchalian also noted that he doesn’t believe that Morales knew nothing about the questionable activities in the agency.

Meanwhile, dialysis facility operator B. Braun Avitum, in a statement, said it fully supports the Senate’s current PhilHealth probe. “We are one with the government in its quest for transparency and good governance and will extend full cooperation in this endeavor,” it said.

“During the ongoing pandemic, the funds made available through the IRM to support the operations of all Philippine healthcare institutions (HCIs) have enabled B. Braun Avitum to provide quality renal services to dialysis patients who require regular treatment,” their statement read.

B. Braun said it is unfazed by the added issues brought up by Lacson and Keith that B. Braun is allegedly the same healthcare institution involved in the P9.7 million wrongly miscredited to Balanga Rural Bank in Bataan in May 2019.

NBI probe

The National Bureau of Investigation (NBI) yesterday created a task force that would investigate alleged PhilHealth anomalies.

“In line with the directive of Secretary of Justice Menardo Guevarra, NBI officer-in-charge Eric Distor issued a memorandum order creating Task Force PhilHealth that will conduct investigation on various allegations of corruption and anomalies in PhilHealth,” the NBI said.

The task force will be composed of agents and investigators from the bureau’s Anti-Graft Division, Anti-Fraud Division, Special Action Unit, Computer Crimes Division, Special Operations Group and Digital Forensic Laboratory.

The group will be headed by NBI-NCR regional director Cesar Bacani and shall be under the supervision of NBI deputies for regional operations service Antonio Pagatpat and Vicente de Guzman III.

Guevarra earlier formed an inter-agency task force dubbed Task Force Health to probe the reported anomalous activities in PhilHealth and its regional offices.

Aside from the NBI, the task force includes the Office of the Ombudsman, Commission on Audit, Civil Service Commission, Office of the President and Anti-Money Laundering Council (AMLC).

The NBI team will also audit the finances and conduct lifestyle checks on PhilHealth officials and employees.

In 2019, the NBI conducted an investigation on PhilHealth regarding the ghost dialysis fees involving WellMed Dialysis and Laboratory Center.

It uncovered dialysis claims of patient-members who were already dead.

The AMLC is assisting in the investigation into the alleged PhilHealth irregularities.

“Since the AMLC has already been tapped to assist in the investigation, it is unable to provide details further than what has been disclosed by the task force lead,” AMLC said in an e-mail message to The STAR.

Several executives of PhilHealth have agreed to sign waivers to allow AMLC to scrutinize their banks accounts.

The officials include senior vice presidents Renato Limsiaco Jr., Jovita Aragona, Shirley Domingo, Oscar Abadu and Gilda Diaz as well as senior vice president for health finance policy Israel Paragas, senior vice president for actuarial services Nerissa Santiago, corporate secretary Jonathan Mangaoang and vice president for Visayas Walter Bacareza.

Roque said President Duterte has not asked Morales to sign bank secrecy waivers.

Privatization

House assistant minority leader Marikina Rep. Stella Quimbo yesterday proposed the privatization of PhilHealth amid the investigation of alleged corruption in the agency.

Quimbo urged Malacañang to consider privatization for better management of the state insurance firm, which she said is a complicated matter better suited for health insurance professionals.

“We cannot rely on ‘learning by doing’ when it comes to managing a social health insurance fund that receives subsidies and premium contributions from government employees of close to P100 billion every year. If this does not work, government should begin to consider privatizing the fund management,” she said.

Quimbo said there were reports that PhilHealth lost some P15.4 billion to fraud relating to excess pneumonia payments from 2014 to 2018.

She said fund leakages due to fraudulent claims for pneumonia – whether due to ghost claims or upcasing – is estimated at P3.6 billion for 2018.

Bulacan Rep. Jonathan Sy Alvarado, chairman of the House committee on good government, said PhilHealth paid hundreds of millions of pesos in reimbursements to private hospitals but owed government specialty hospitals millions of pesos.

Alvarado said yesteday that he found this out when members of his staff made the rounds in public hospitals in Metro Manila that include the National Kidney and Transplant Institute, Lung Center of the Philippines, Philippine Children’s Medical Center and Heart Center of the Philippines and some hospitals in Bulacan. — Alexis Romero, Cecille Suerte Felipe, Rey Galupo, Delon Porcalla, Edu Punay