PhilHealth not running out of funds; eye center denies bloated figures

Department of Health (DOH) Secretary Janette Garin yesterday dispelled reports PhilHealth is running out of money, saying the state-run health insurance system is in fact expanding its services and coverage for its beneficiaries.

“It’s not true that PhilHealth is running out of money. It’s not true, in fact, we expanded our dialysis program for senior citizens and other programs,” Garin told the Senate Blue Ribbon Committee which is investigating the fraudulent cataract operations and alleged suspicious reimbursement of some eye doctors accused of milking the agency’s funds.

The panel, chaired by Senator Teofisto “TG” Guingona III, had earlier launched an investigation into the allegation after noting the unusual health insurance reimbursements with PhilHealth amounting to billions of pesos apart from reports some of the cataract patients went blind after a botched operation.

Garin, during the hearing, assured that PhilHealth continues to fulfill its mandate even if it is investigating the various anomalies or complaints on some doctors and health institutions.

“PhilHealth’s funds are not the government’s money, they are members’ contributions as well as from sin tax revenues,” Garin said.

Garin offered the explanation after the Quezon City Eye Center (QCEC) scored PhilHealth for its decision to suspend payment for reimbursements on eye treatment. QCEC is one of the eye centers that is under investigation.

The move, according to Raymond Evangelista, CEO and President of QCEC, appears to solely and unfairly rest on “bloated figures” that do not do justice to the important work the center does for its patients.

“This matter has not been clarified and I don’t see any effort of any kind to clear this up, it is a very big spread and it’s a very big problem,” Evangelista added, referring to the failure of PhilHealth to correct the figures.

Earlier, PhilHealth claimed QCEC had a total reimbursement of 156 million in 2014. But according to Evangelista, PhilHealth bloated the figures as QCEC only received a total of 110 million from the agency and that already includes the professional fees of doctors.

Evangelista also said the basis of the investigation is questionable since the top 10 list released by Philhealth is only limited to small eye centers and did not include cataract surgeries performed by various hospitals.

“I’m sure the list will be different if PhilHealth will correct its figures and include the reimbursements of hospitals,” he pointed out.

Also, Evangelista also said QCEC is still waiting for PhilHealth’s Committee on Administrative Cases Against Health Care Providers and Members (CAAC) to act on their pending cases which, up to now, has yet to be resolved.

“We are still waiting for the CAAC’s resolution on the cases so that we can move on,” Evangelista said, adding that the agency’s recent action against QCEC damaged the center’s reputation unnecessarily.

“We always welcome any probe into perceived mistakes and wrongdoing, because we all want to stamp out corruption. We are really willing to help,” Evangelista explained.

“But let us be fair and careful in doing this because a lot of people’s lives and integrity are in stake here. It’s not easy to study and become a doctor. We dedicated almost half our lives to studying and to be best in our crafts. Not all of us are willing to commit fraud to the detriment of our integrity,” he pointed out.

“Because of unfair and careless treatment to eye clinics and doctors, PhilHealth’ actions continue to affect thousands of patients who are unnecessarily burdened,” he reiterated.

Also during the hearing, Guingona took the DOH to task on the pending cases before the CAAC.

Nicolas Lutero III, DOH assistant secretary, told the Senate that as part of their regular monitoring, they have already looked into the cases of more than 38 clinics specifically dealing with eye problems.

According to Lutero, they were prompted to monitor them due to their proximity to Metro Manila.

“It’s easier for us to monitor them before we spread out to the provinces because of our limited resources,” Lutero told the Senate panel.

But this did not sit well with Guingona who said “it has come to our attention that in the past” the DOH and PhilHealth “do not walk in tandem.”

“Sometimes what PhilHealth does is not also followed up by the DOH,” the senator pointed out.

“How many people have to go blind before we do an honest to goodness nationwide, wag lang yung proximity to Metro Manila, proper monitoring sa mga facilities?” Guingona lamented.