51 hospitals with fraud cases still got ₱1.49 B from PhilHealth — lawmaker

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Metro Manila (CNN Philippines, August 17) — A total of 51 hospitals with fraud cases have received around ₱1.49 billion from the Philippine Health Insurance Corporation, a House panel chair bared on Monday.

During the joint hearing of the House Committee on Public Accounts and Committee on Good Government and Public Accountability, Anakalusugan Partylist Rep. Mike Defensor said the hospitals received ₱1,493,554,124 from its interim reimbursement mechanism (IRM) despite pending resolution on their fraudulent cases.

The IRM, an emergency fund advanced to hospitals in case of "fortuitous events" such as floods and typhoons, was suspended last week due to numerous irregularities.

In his presentation, Defensor said that from 2013 to 2020, there were 4,664 recorded fraudulent cases by various health care institutions. These include padding and post-dating of claims, and fabricating necessary documents, among others.

“Sa mata ng publiko...kung ganito na may mga fraud cases ang mga ospital at institusyon at bibigyan pa rin ng pondo ng PhilHealth, nakakatakot itong batayan, nakakatakot itong ehemplo,” Defensor said.

[Translation: In the eyes of the public, if hospitals and institutions with fraud cases still receive funds from PhilHealth, it’s a horrifying basis, a horrifying example.]

PhilHealth previously claimed that the inclusion of COVID-19 cases in the IRM program was valid, even before the national government recognized the severity of the crisis

Meanwhile, Marikina 2nd District Rep. Stella Quimbo questioned the allocation of IRM based on the capacity of a hospital. She said that based on her estimates and assuming that there is an average of P243,000 of IRM per bed, there are 14 hospitals whose IRM exceeds the average amount.

She added that there are even hospitals in the National Capital Region who were given lower IRM allocations despite having more COVID-19 cases compared to other regions.

IRM can be used for both claims and operations

Quimbo asked PhilHealth SVP for fund management sector Renato Limsiaco Jr. if the IRM claims can also be used to fund their operating costs like buying supplies, paying salaries of personnel, and the like.

Limsiaco confirmed this to which Quimbo said this might be the reason behind the slow liquidation of process. It was noted during the hearing that of about P14 billion worth of IRM claims disbursed to healthcare facilities, only P2.7 billion have been liquidated.

Quimbo said that with this system, it would seem like that the IRM is like a “blank check” being given to hospitals which they can spend however they want, making way for fraudulent acts.

She added that due to fraud, PhilHealth could lose about P2 billion from the P26.8-billion IRM fund, as well as P541 million in forgone investment opportunities.

With this, Defensor made a move for a unanimous call to suspend the IRM and to withdraw all funds under it.

Earlier, PhilHealth said it suspended the release of the cash advances, pending review of the program.

The agency is also being questioned for including dialysis and maternity clinics that did not treat COVID-19 cases.

Some PhilHealth officials were also accused of pocketing some ₱15 billion from the agency using different fraudulent schemes.