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Go presses PhilHealth execs for truth about ‘fraudulent’ claims

/ 05:19 PM August 21, 2019
Christopher Go at Senate hearing

Sen. Christopher Lawrence “Bong” Go asks PhilHealth officials questions about alleged anomalies during a Senate hearing last Wednesday, Aug. 14, 2019. (Photo from his office)

MANILA, Philippines — “The people deserve to know the truth and the seated officials must provide solutions, not excuses.”

This is what Sen. Christopher Lawrence “Bong” Go said on Wednesday, Aug. 14, during the Senate inquiry on the alleged anomalies involving the Philippine Health Insurance Corp. (PhilHealth).

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“Kailangang malaman ng Senado at ng taumbayan ang katotohanan sa isyung ito. Interes ng bawat Pilipino ang dapat manguna,” Go said in his opening statement.

[The Senate and the people have to know the truth about this issue. The interest of every Filipino has to come first.]

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The Senate Committee on Health, which Go chairs, and the Senate Blue Ribbon Committee, headed by Sen. Richard Gordon, are conducting a joint investigation on the alleged fraudulent claims that PhilHealth granted to certain health care facilities and providers, including WellMed Dialysis and Laboratory Center (WellMed).

WellMed, which is based in Quezon City, allegedly filed falsified benefit claims with PhilHealth on behalf of deceased patients, receiving at least P800,000 using this scheme.

So many stages of review

Go questioned past and present PhilHealth officials on how the claims were able to pass through several stages of review.

“May submission of claims and then adjudication by benefits. May administration sector. So dadaan at i-tse-check ninyo. Then medical review by doctors, i-tse-check ninyo, and then payment approval. Puro po ito sa PhilHealth. So bakit po nakakalusot itong mga upcasing, itong mga overpayment, itong fraudulent claims?” the Senator asked.

[There was the submission of claims and then adjudication by benefits. There was an administration sector. So it will pass through that and you will check them. Then there’s a medical review by doctors. You will check them. And then payment approval. All that was in PhilHealth. So how did they slip through — all these upcasing, these overpayments, these fraudulent claims?]

Gilda Diaz, PhilHealth’s vice president for the National Capital Region, admitted that the claims system of the state-run corporation failed to detect the anomalies.

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“Yung sinasabi po nilang ghost claims po, hindi ho talaga siya na-detect sa claims system namin,” Diaz said.

[The so-called ghost claims were not really detected by our claims system.]

She said that her office only learned of the case when the investigation was done and PhilHealth had to withdraw WellMed’s accreditation.

“The [PhilHealth Regional Office – National Capitol Region] was not also informed of the whistleblowers, of the investigation going on. We learned about the fraud activities only in late January po, when the fact-finding investigation and the Enforcement Department informed the Accreditation Department, kasi hiniling po namin na ma-withdraw po ang accreditation ng WellMed,” Diaz said.

“That is the time when we learned of the fraud activities po. The [PRO NCR] recommended the withdrawal of the accreditation to the head office,” she added.0

‘In cahoots’

Go asked the same question to Dr. Roy Ferrer, who served as PhilHealth acting president and CEO from June 2018 to June 2019.

“Dr. Ferrer, paano nalusutan? Pakisagot. Paano nalusutan? Ang daming layer po na dinadaanan. Bakit po nalusutan? At meron bang kuntsaba with PhilHealth officials?” Go asked.

[Dr. Ferrer, how did all these slip through? Please answer. How did they slip through? There were so many layers that had to be passed. How did these slip through? And was there collusion among PhilHealth officials?]

In reply, Ferrer said: “Ang kulang po natin ay talagang mga doctors na nasa field to check.”

[What we really lack are doctors on the field to check.]

“Not necessarily doctors but health professionals,” he added. “In fact, during my time, I even asked nurses to be trained so that they will be able to know whether these claims are valid and there is a reason for [the patients] to be admitted or not.”

But Ferrer also admitted that corruption exists within the ranks of PhilHealth.

“We cannot deny that some of our employees are in cahoots [with private hospitals],” he said.

The answer incensed Go, and he challenged former Gen. Ricardo “Dick” Morales, the newly appointed PhilHealth president, to address the problem.

“Ah ‘yon, sinagot mo na. ‘Yan ang gusto namin malaman, ‘yung kuntsaba, in cahoots. Kasi bakit nga ‘yung WellMed nabayaran pa rin despite of allegations of fraud. Galing na rin po sa bunganga mo na ‘in cahoots’ with the employees. So I challenge the new management. To General Morales: Sir, baka po pwede na gawan ninyo ng paraan na talagang walang makakalusot ni piso sa inyong mga kamay, under your new management po.”

[Ah, so you have answered the question. That’s what we want to know — whether there was collusion, whether they were in cahoots, considering that WellMed was paid despite allegations of fraud. You said it yourself that they were ‘in cahoots’ with the employees. So I challenge the new management. To General Morales: Sir, maybe you can find a way to ensure that not even a single peso would slip through your fingers, under your new management.]

‘Anomalies must stop’

In his opening statement, Go also said that he would not take sides and would remain true to his oath as a senator.

“Wala po akong kinikilingan. Kahit kaibigan o dating katrabaho ang sangkot, kahit na tumulong noong kampanya, kahit nagpapawis noong kampanya sa amin, gagawin ko ang nararapat. Tutuparin ko ang aking sinumpaang tungkulin.”

[I’m not favoring anyone. Even friends or former co-workers were involved, even those who helped in my campaign, I will do what is right. I will fulfill my sworn duty.]

The Senator also expressed his disappointment over how health care officials address corruption issues. “Matagal na pong issue ito. Noon pang 2015, nag-hearing na ang Blue Ribbon tungkol sa fraudulent claims, subalit hanggang ngayon, patuloy ang mga illegal na gawain sa PhilHealth. Tuwing mayroong anomalya o kontrobersya, puro rason, puro palusot ang naririnig natin. Ang gustong marinig ng taong bayan, solusyon naman.”

Echoing President Rodrigo Duterte, Go stressed that the anomalies must stop. He urged the Department of Justice to refile the case against WellMed, which allegedly claimed payments from PhilHealth for “ghost” dialysis sessions under the name of patients who had already died.

The Quezon City Regional Trial Court recently dismissed the case for “lack of jurisdiction.”

“Hindi na dapat magpatuloy ang anomalya sa PhilHealth. Sabi nga ng ating Pangulo, hindi tayo papayag — not even a whiff of corruption. Dapat managot ang dapat managot. Sa kaso ng WellMed, I urge the DOJ to refile the case [in] the appropriate court at palakasin pa ang kaso para siguradong may mapaparusahan,” Go said.

[The anomalies at PhilHealth should not be allowed to continue. As our President said, we would not allow it — not even a whiff of corruption. Those who are responsible should be held responsible. In the case of WellMed, I urge the DOJ to case in the appropriate court and strengthen its case so that we can be sure that someone would be punished.]

Go urged PhilHealth to clean up and fix its systems in preparation for the implementation of the Universal Health Care Law.

“Next year is the first year of the implementation of the Universal Health Care Law,” he said. “Around P250 billion po ang funding requirement nito. Bago pa man ma-implement ito, linisin na natin ang PhilHealth.”

He expressed his trust in the newly installed officials of PhilHealth.

“Malaki po ang tiwala ko sa pamunuan ng bagong PhilHealth headed by [former] General Dick Morales at sa mga bagong board members,” he said.

He also reminded officials that the money being spent on health care comes from the people and should be spent on the people.

“Ang pasyente ay hindi dapat nagmamakaawa sa atin para sa tulong dahil pera nila yan. Pera ‘yan ng taong bayan,” he said. “They deserve quality health service mula sa ating health officials. Ang hirap at sakit po isipin na nawawala at nasasayang lang ang pondo natin para sa health care dahil sa korapsyon.”

[Patients should not have to beg to us for help because it is their money. That money belongs to the people. They deserve quality health service from our health officials. It’s hard and painful to think that our health care funds are lost and wasted because of corruption.]

/atm

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