MANILA, Philippines — Health Secretary Francisco Duque III on Monday said he was clueless about Sen. Panfilo “Ping” Lacson’s “bigger exposé” against him as he dismissed the lawmaker’s call for him to resign.
“First of all, I have a job to do upon the orders of President Duterte. He is my appointing power. He was the one who appointed me, so if there’s an issue, we have to talk about it,” Duque said in a TV interview.
He said the President had asked him to focus on the PhilHealth issue and the implementation of the Universal Health Care Act.
Lacson earlier said that Duque should have voluntarily resigned amid the investigation of PhilHealth officials who might be involved in defrauding the government of about P154 billion through bogus medical claims.
The senator also said he was preparing evidence that would expose another plunder issue involving the health secretary.
Duque said he was clueless about Lacson’s allegations.
“I have no knowledge of what he is talking about. We have no idea. In all honesty, I don’t know what Senator Lacson is talking about,” he said.
Lost to fraud
The health secretary also belied claims by PhilHealth insiders that P154 billion was lost to overpayments and fraud from 2013 to 2018.
“We looked into it. There’s actually no basis on the P154-billion fraud [claim]. They are just applying the data in Northern Mindanao as a national fact, which has no analysis,” Duque said.
“It has no basis and it was not even backed by Commission on Audit (COA) report,” he added.
Duque said he had been trying to reach out to Lacson to discuss the issues against him.
The COA has flagged PhilHealth for overpayments in recent years.
In 2018, PhilHealth paid hospitals P10.94 billion for more than 757,000 members who were purportedly stricken with pneumonia.
No pneumonia outbreak
While the number of cases reached “epidemic proportions,” the Department of Health (DOH) did not declare an outbreak of pneumonia, a lung infection.
DOH records showed there were more than 454,000 reported pneumonia cases in 2017. In contrast, PhilHealth processed 707,133 pneumonia claims for that year.
Comparing the records and processed cases, PhilHealth incurred a loss of P3.2 billion as it spent P10.2 billion for pneumonia cases alone in 2017.
Experts traced PhilHealth’s financial troubles to its allegedly flawed all-case rates payment scheme that was introduced in 2011.
The scheme guaranteed definite amounts in benefit claims for hospitalization or surgery among the agency’s 85 million members.
Of the P154-billion “losses” incurred over the past six years, P102.5 billion was due to overpayment, the COA said.
The amount was calculated using the 2014 audit observation memorandum of the COA for Northern Mindanao, which found that PhilHealth had overpaid in 20 percent of all cases it processed.
Another P51.2 billion was lost to fraud based on the global estimate of a 10-percent loss as a result of health care insurance scams.