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PhilHealth OKs P600-M denied hospital claims. September 3, 2020

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PhilHealth OKs P600-M denied hospital claims

By Melvin Gascon

An administration lawmaker on Thursday deplored another irregularity in Philippine Health Insurance Corp. (PhilHealth) involving the grant of amnesty to delinquent hospitals that had been claiming payments for eight years.

Surigao del Norte Rep. Robert Ace Barbers blasted unscrupulous PhilHealth officials for entering into allegedly questionable deals, which, he said, was done “without much thought and replete with doubtful details.”

‘Don’t we have a problem?’
Barbers, who spoke about the amnesty toward the conclusion of the joint hearings of the House committees on good government and on public accounts on Wednesday, questioned PhilHealth officials on their May 14 board approval allowing the payment of more than P600 million to hospitals with previously rejected claims from 2011 to 2019.

“They are authorizing PhilHealth to release P600 million to settle all these claims, supposedly because we are in the middle of a pandemic and the [hospitals] need financial security,” Barbers said.

“If most of these were from as early as 2011, and you are saying we are supposed to grant them amnesty, don’t we have a problem here?” he asked.

According to Barbers, various hospitals in the country had been claiming payments from PhilHealth since 2011, reportedly totaling about P4 billion, which the state-run health insurer’s Protest Appeals and Review Department (PARD) had rejected.

But in May this year, the PARD reversed its decisions and decided to grant its version of amnesty by paying all these hospitals, Barbers said.

“However, the board only allowed a little over P600 million to be paid, out of a total of more than P4 billion in claims,” he said.

Barbers took to task lawyer Rodolfo del Rosario Jr., a former PhilHealth senior vice president, who supposedly had overseen the PARD, and lawyer Michael Roy Polintan, acting senior manager, and the PhilHealth “mafia” over the amnesty grant.

“With the lame excuse of helping these hospitals cope with the [coronavirus] pandemic, [PhilHealth] suddenly became generous and considerate after years of neglecting these claims,” Barbers said.

Still being routed
In his response, lawyer Jonathan Mangaoang, PhilHealth corporate secretary, confirmed that the questioned resolution indeed was passed by the board, but clarified that the document was “still being routed for signatures.”

He did not say, however, how much of the P600 million approved payments was actually paid.

Cavite Rep. Elpidio Barzaga Jr. expressed disgust that PhilHealth officials were again devising another fraud while under congressional investigation for alleged corruption in the company.

“This is again a serious case as this involves P600 million. This is too much. They approved the resolution while we [in Congress] are talking about all these [irregularities in PhilHealth],” he said.

Anakalusugan Rep. Michael Defensor directed PhilHealth officials to submit to the House committees all pertinent documents involving the P600-million amnesty, which, he said, would be included as evidence in the graft charges the House would file against them.

A multiagency group led by the Department of Justice (DOJ) is wrapping up an investigation into alleged irregularities in PhilHealth that a whistleblower claimed cost the company P15 billion in 2019 alone.

The scandal has led to the departure of key PhilHealth officials, including Ricardo Morales, who resigned as president and CEO supposedly for health reasons.

President Duterte has appointed former National Bureau of Investigation Director Dante Gierran to replace Morales and directed him to revamp PhilHealth to put an end to endless corruption in the company.

Delegated authority
But Sen. Panfilo Lacson said on Thursday that Mr. Duterte had no statutory power to reorganize PhilHealth, an agency created by law, and that the President would need an act of Congress that would delegate such authority to him.

If the intention is to cleanse PhilHealth, however, Lacson said the President no longer needed delegated authority as he had other agencies such as the DOJ and the NBI to do the job.

“It only takes a strong political will to accomplish the task,” Lacson said.

He suggested that the President start by replacing the PhilHealth chair, Health Secretary Francisco Duque III, with someone “endowed even with little above average leadership traits, competence, honesty and integrity.”

In April, 14 senators, including Lacson, adopted a resolution for Duque’s resignation, accusing the health chief of “failure of leadership, negligence, lack of foresight, and inefficiency in performance.”

Gierran, meanwhile, had admitted to lack of knowledge of public health, but said on Thursday that he would study up on it as he embarked on cleaning up PhilHealth.
“I have to talk to experts. I’ll have to refer to experts to give me inputs,” he told a news briefing.

He said he would also consult Morales, whom the Senate had recommended to be charged for alleged irregularities in PhilHealth.

Gierran said he would reorganize PhilHealth to emasculate the syndicate behind the alleged irregularities, and whip the legal office into shape, as it “legalizes the illegality.”

He said he would also look into the company’s financial statements to determine how much money the company had left. A witness in the Senate investigation had said PhilHealth was in bad financial shape, and that it could run out of money by 2022. —WITH A REPORT FROM LEILA B. SALAVERRIA

Editorial

'The best choice'?

The President named as Ricardo Morales’ successor in PhilHealth Dante Gierran, a lawyer and accountant who retired as chief of the National Bureau of Investigation in February. The Davao native himself expressed reservations about his new post, saying he was "scared" about the "gargantuan job" to clean up PhilHealth. "I don't know about public health. I don't know about that," Gierran admitted in a TV interview. Howls of protest greeted Mr. Duterte’s latest appointment, with critics citing the minimum qualifications required for the job. Under Section 14 of the Universal Health Care law, the president/CEO of PhilHealth must have "at least 7 years of experience in the field of public health, management, finance, and health economics, or a combination of any of these expertise."

"Putting ex-generals, ex-cops and ex-NBI agents with little or no experience in positions where crucial decisions on medical matters and public health are made puts our people’s lives in peril," one doctor said, voicing out a collective concern amid the raging COVID-19 pandemic. With yet another missed opportunity to appoint the right person for the job, lamented other observers, Mr. Duterte has put into serious doubt his promise to reform PhilHealth and provide more transparency in the process. Indeed, the President was not to be dislodged from his habits, not even by the worst health emergency in the country's history. For the umpteenth time, he turned to another former law enforcement official to take on a job that would certainly benefit more from the experience and expertise of a career officer, in this case a bona fide health professional who can hit the ground running and rebuild PhilHealth posthaste given the urgency and severity of the COVID-19 crisis.

Read full story: opinion.inquirer.net