Senators deplore inability of PhilHealth to detect fraud on its own
MANILA, Philippines — “Ludicrous.”
This was how Senator Richard Gordon described the admission of Philippine Health Insurance Corporation (PhilHealth) President Ricardo Morales that the state insurance company would need “whistleblowers” to unearth fraudulent transactions in the agency.
During the hearing of the Senate Blue Ribbon Committee, which Gordon chairs, Senate Minority Leader Franklin Drilon pressed Morales on where anomalies within PhilHealth take place.
The Senate Blue Ribbon Committee is conducting a Senate investigation into alleged corruption and fraud in PhilHealth.
“Maybe we have a general idea of where the anomalies take place? Gusto ko lang po malaman, saan po nangyayari ang katiwalian sa PhilHealth at sino po ang responsible. Without naming names first. Is it the claims? Is it the service provider?” Drilon asked.
But Morales could not give a categorical answer.
He said that anomalies “can happen at any point in the process.”
“PhilHealth is a very large and complicated organization, we handle 10 million claims a month… Some of these have to be handled manually because they cannot be fed automatically into the system,” Morales explained.
However, the PhilHealth official’s answer did not sit well with Drilon.
“We could never stop this anomalies because the claims are overwhelming? I don’t think anybody would accept that,” the senator said.
Gordon then followed up on Drilon’s questions and asked Morales to name “beneath-the-radar” fraudulent transactions in the agency.
“The WellMed case… if there were no whistleblowers we would never know about it,” Morales said.
Gordon then asked: “So you need a whistlebower?”
“In most cases,” the PhilHealth president answered.
“I find it ludicrous for you to say, ‘Kailangan may whistleblower.’ Because the system is made to prevent such fraudulent transactions, dapat nakabantay kayo diyan dapat araw-araw meron kayong monitoring anong pumasok na pera,” Gordon pointed out.
To recall, the Philippine Daily Inquirer reported in June about “ghost” dialysis treatments allegedly being paid by PhilHealth, as exposed by former employees of WellMed Dialysis & Laboratory Center Corp. (WellMed).
According to the report, WellMed collected payments from PhilHealth for dialysis treatments that were administered to patients who either already stopped their treatments or were already deceased.
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