Senators scold PhilHealth for lack of safeguards

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SENATORS on Wednesday scolded officials of the Philippine Health Insurance Corporation (PhilHealth) for failing to enforce safeguards against fraud.

During a Senate investigation of fraudulent transactions at the state-owned company that takes care of universal health care coverage, lawmakers said PhilHealth is supposed to have a built-in system to prevent anomalies.

At the hearing, PhilHealth President Ricardo Morales said the state insurance company needs whistle-blowers.

“I find it ludicrous for you to say ‘We need a whistle-blower’ because the system is made to prevent such fraudulent transactions,” said Senator Richard Gordon, who heads the blue ribbon committee. He added that PhilHealth officials should monitor transactions daily.

Before Mr. Gordon’s questioning, Senator Franklin Drilon asked PhilHealth officials where anomalies within the organization usually take place. “At what stage do they happen?” he asked.

Mr. Morales, a retired Army general, claimed anomalies could “happen at any point in the process,” adding that it is impossible to stop all fraud because of the sheer number of insurance claims that they handle.

“PhilHealth is a very large and complicated organization. We handle 10 million claims a month,” he said, noting that some transactions have to be handled manually.

An irked Mr. Drilon said: “We can never stop these anomalies because the claims are overwhelming? I don’t think anybody would accept that.”

Mr. Morales said the fraud involving “ghost” dialysis treatments would not have been discovered without whistle-blowers. “The anti-fraud mechanisms in PhilHealth do not appear to be working,” he also said.

Former employees of WellMed Dialysis & Laboratory Center Corp. have accused the company of collecting payments from PhilHealth for the dialysis of patients who had either stopped treatments or died, according to a Philippine Daily Inquirer report in June.

Also yesterday, Senator Manuel “Lito” Lapid said he had filed a bill seeking to increase the penalty for fraudulent claims on mandatory employee contributions and benefits from PhilHealth, Social Security System (SSS) and Pag-IBIG Fund.

“This is in response to recent reported cases of ghost patients from PhilHealth, ghost borrowers of Pag-IBIG loans and bogus claimants of SSS benefits,” the lawmaker said in a statement.

Under Senate Bill 837, the penalty on a member, property developer and health care provider who causes the filing of a fraudulent claim for benefits will be reclusion temporal or a jail term of 12 to 20 years to reclusion perpetual or a jail term of 20 to 40 years.

Syndicates will be slapped a more serious penalty of life imprisonment. The bill also makes the offense non-bailable.