No syndicate committing fraud in PhilHealth – Morales

MANILA, Philippines — There have been “inefficiencies” within the Philippine Health Insurance Corp. (PhilHealth) since it handles a huge fund, but there is no syndicate within it committing large scale fraud, according to its president Ricardo Morales.

Morales on Monday said it would be premature to meet with President Rodrigo Duterte to discuss the alleged corruption within the state insurance firm, as proposed by presidential spokesperson Harry Roque.

Morales said he received a report from the Commission on Audit saying it could not substantiate the allegation that it lost P154 billion due to fraud from 2013 to 2017.

But he said that whatever lapses there were in PhilHealth were due to inefficiencies.

He noted that PhilHealth processes some 50,000 claims a day in 16 regional offices and 120 branches. Some of these are done manually.

“Given the huge number, volume of transactions, there are inefficiencies. But I can assure you that there is no group of people colluding with each other to defraud PhilHealth in the scale reported. There is none,” he said at a recent briefing.

Some documents may have been filed incorrectly or forms filled out incorrectly, he added.

According to him, no health care system in the world is completely fraud-free because face to face transactions between the physician and patient cannot be removed.

“But we can reduce it if we have a perfectly integrated and harmonized information system,” he said.

This system would take some time to put in place but PhilHealth is moving toward automation, he added.

Asked about Morales’ statement that a meeting with the President was premature, Roque said he would let the public judge the issue and would leave the matter to Duterte.

Roque earlier said Morales should take action against corruption in the PhilHealth, as this has been depleting its fund.

Meanwhile, Morales assured the public that the agency has enough funds to sustain operations even as he suggested earlier to delay the full implementation of the Universal Health Care (UHC) due to declining revenue amid the COVID-19 pandemic.

“Yes, we have money. We’ll be fine for this year and maybe up to the middle of next year. There is nothing to worry about,” said Morales during the press briefing.

“PhilHealth services will not diminish. We’ll continue to give the same level of services to the people,” he added.

According to Morales, PhilHealth started the year with a reserve of about P130 billion, with COVID-19 price tag estimated at P40 billion.

“So far, PhilHealth has paid out P52.5 billion as of end-April,” he said.

Morales said the issue delaying the UHC law implementation was still under discussion.

“The reason for that is because we’re looking at our cash flow and we saw that there might be a decline in our [revenue] collection since the economy stopped, our directly paying members couldn’t work so our collection suffered. That was the reason why we informed our policymakers that we might be facing a problem,” he said.

“But it has not yet been decided,” he added, stressing that policymakers, not him, will decide on the matter.