New PhilHealth chief readies major revamp

MANILA, Philippines — Retired Gen. Ricardo Morales, the newly installed president and CEO of Philippine Health Insurance Corp. (PhilHealth), vowed on Tuesday to implement a sweeping reorganization of the embattled state insurer in order to “plug the leaks” that had cost it billions in public funds.

“We will be conducting a study on this—what changes have to be made, positions that are going to be created, positions that are going to be merged,” Morales said in his first press conference as PhilHealth chief.

“The purpose is to be efficient and economical,” he said.

The former Metropolitan Waterworks and Sewerage System trustee is taking the helm of the PhilHealth at a precarious time for the agency, which is still reeling from allegations of massive corruption and mismanagement as it prepares to implement the landmark Universal Health Care (UHC) Act.

Morales said he was convinced of the need to reorganize after finding that the firm had a backlog of about 15,000 unresolved administrative cases since 2015 that were filed against at least 400 institutions.

“How is [the reorganization] going to look? I still do not know,” Morales said.

But PhilHealth’s structure should be simple, he added, similar to how the famed French military leader Napoleon Bonaparte only spoke with two other officials — his chiefs of supply and operations.

Redundant claims

PhilHealth senior vice president Rodolfo del Rosario said the 15,000 cases pending before the insurer mostly had to do with redundant claims and “upcasing,” or when hospitals file claims for serious ailments even if patients only had a cough, for example, to get higher reimbursements.

These overpayments were one of the prime drivers behind the P154-billion losses that PhilHealth had incurred since 2013.

“We have to plug these leaks so that we don’t run out of money,” Morales said.

He said his top priority would be the resolution of the oldest cases and those that involved the largest amounts of money among the 15,000, especially as the PhilHealth readies itself for the implementation of the UHC Act, which has an initial fund of P257 billion.

Once the UHC Act is in full swing, insurance claims are expected to double from 1 million to 2 million per month, he said.

The retired military official and Davao native is the fourth person to serve as PhilHealth chief since the start of Mr. Duterte’s term. He replaced Roy Ferrer, who was asked to resign with six other board members amid revelations about payments the PhilHealth had made for “ghost” dialysis treatments.