MANILA, Philippines — Documents won’t lie.
Sifting through the financial records of Philippine Health Insurance Corp. (PhilHealth) could be the key to unmasking the real members of the so-called mafia who were supposedly controlling the affairs of the state insurance firm, Sen. Panfilo Lacson on Sunday said.
“One of the means for us to find out [the members of] the mafia is to check the paper trail. The documents will not lie. Where did the overpayments originate?” he told the Inquirer in a phone interview.
Lacson made the proposal as Senate Minority Leader Franklin Drilon called on the Commission on Audit (COA) to step in and immediately conduct a special audit of PhilHealth’s transactions to determine its financial health.
“An annual audit is not enough, given that a lot of issues were raised, including overpayments, underpayments and nonpayment of claims,” Drilon said in a radio interview.
Overpayments to hospitals
“We should not stop until we get to the bottom of this issue so we can come up with solutions and legislation to prevent corruption, increase the agency’s collection efficiency and improve claims processing and benefit development,” he added.
Lacson also wanted to know if hospitals and other private health care providers implicated in the fraud schemes received the alleged overpayments, which could reach billions of pesos, that PhilHealth made in the past several years.
“There’s no showing that the hospitals got the overpayments. For all we know, the money did not actually reach them,” he said.
Lacson said he would ask Senators Richard Gordon and Bong Go, who were jointly presiding over the Senate inquiry into the PhilHealth fund mess, to invite to the next hearing officials of hospitals involved in alleged irregular transactions.
At the Senate hearing last week, former PhilHealth president and CEO Roy Ferrer divulged that eight PhilHealth officials made up the “mafia,” supposedly led by a “Mindanao group.”
Dr. Roberto Salvador, who resigned as PhilHealth board member along with Ferrer and several others in the wake of the Inquirer’s series of reports on corruption plaguing the state insurance company, identified them as Khaliquzzaman Macabato, regional vice president (RVP) in the Autonomous Region in Muslim Mindanao; lawyer Valerie Anne Hollero, assistant corporate secretary; and Datu Masiding Alonto Jr., RVP for Northern Mindanao.
Salvador said William Chavez, RVP for Central Visayas; Paolo Johann Perez, RVP for Mimaropa; Dennis Adre, RVP for Davao; lawyer Jelbert Galicto, RVP for Caraga; and Dr. Miriam Grace Pamonag, former RVP for Central Mindanao, also belonged to the supposed shadow organization.
‘Mafia influence’
But Lacson pointed out that while Salvador claimed that the eight wielded influence in PhilHealth, they had been suspended for mere administrative offenses while one of them had been dismissed from the service.
Contrary to Salvador’s allegation, he said former Health Secretary Paulyn Ubial was forced to quit after the Commission on Appointments rejected her designation in October 2017, and not because of the “mafia.”
In a statement, the eight PhilHealth executives turned the tables on their former superiors, saying Ferrer and Salvador were using them as “scapegoats” for their “incompetence.”
“We can resolve the finger-pointing because we will look for the paper trail,” Lacson said.
Dashboard system
Lacson noted that PhilHealth had actually adopted a dashboard system showing all its financial transactions during the time of former Health Secretary Janette Garin.
The senator said he used the information from the PhilHealth dashboard and the COA in his privilege speech on July 29, where he claimed that the health insurance system lost about P154 billion in overpayments and other illegal transactions from 2013 to 2017.
Said Lacson: “If you go by the paper trail, you will see where the overpayments were implemented. Apparently, it did not happen in the regional level. The payments were approved by the central office [of PhilHealth].”
If the hospitals had received payments more than the actual medical expenses incurred by PhilHealth members, they should have notified the health insurance firm and returned the money, he said.
“It’s like withdrawing money from the bank. If you received an amount which is more than what you withdrew, you should return the [extra cash], right?” Lacson said. “Either way, somebody should be held accountable.”