51 hospitals with pending cases received R1.49 B from PhilHealth – Defensor

At least 51 hospitals, including leading tertiary care medical establishments in Metro Manila, with pending cases of fraud, have received Interim Refund Mechanism funds totaling ₱1.49 billion from the Philippine Health Insurance Corporation (PhilHealth).

Anakalusugan Party-list Rep. Mike Defensor aired this claim as he presided over the continuation of the virtual committee hearing jointly conducted by the Committees on Public Account and on Good Government.

“I am as surprised even as you are guys,” PhilHealth board member Alejandro Cabading said when asked about it.

“I was also surprised that the idea of when liquidation should take place was not discussed,”

said.

Cabading, identified as among the whistleblowers who aired willingness to expose widespread fund anomalies in the state insurer, said the PhilHealth management even issued a memorandum making liquidation of IRM optional.

“Another surprise is that there was a memorandum issued making liquidation of IRM optional, I thought this was a really ill-thought idea,” said Cabading.

In his opening statement, Defensor said PhilHealth must clarify why the state-run firm distributed millions of pesos to each of the 51 hospitals despite the fact that fraud cases against them have yet to be resolved.

These hospitals each received ₱4 million to over ₱100 million in IRM or emergency funds advanced by the insurer to cover claims of hospitalized members due to natural disasters, epidemic, or other fortuitous events.

“Sa mata ng publiko, sa mata namin, kung ganitong may mga fraud cases ang mga ospital at institusyon at bibigyan pa rin ng pondo ng PhilHealth, nakakatakot itong batayan, nakakatakot itong ehemplo, (In our opinion and that of the public, the basis of granting hospitals Philhealth funds despite facing fraud cases is scary, this is an alarming example),” said Defensor.

The senior administration lawmaker noted that the 51 hospitals were among those with pending cases of suspected fraud reported from 2013 to 2020.

During the seven-year period, PhilHealth admitted that 4,664 cases were being investigated. Of this number, over 3,000 cases were reported from 2019 to 2020.

Aside from tertiary care medical private medical institutions, many IRM recipients were private dialysis centers and clinics.

Among the cases being investigated were offenses such as padding of claims, claims for non-admitted or non-treated patients; post-dating claims for non-admitted or nontreated patients, extending the period of confinement, misrepresentation by furnishing false information, unjustified admission beyond accredited bed capacity, unauthorized operations beyond service capability, and fabrication or possession of fabricated forms.