PhilHealth defends SVP in flagged fund releases

MANILA, Philippines — The state-run Philippine Health Insurance Corp. (PhilHealth) maintained that its release of cash advances to hospitals to support their COVID-19 response was “aboveboard” as it belied allegations that one of its senior officials favored some hospitals for the fund disbursement.

PhilHealth President and CEO Ricardo Morales reiterated that the corporation made available to all hospitals the P30-billion fund under the interim reimbursement mechanism (IRM) as a way “to ensure unhampered health services to all Filipinos.”

As it was unclear in late March what areas would see a spike in infections, “it necessitated funds [to be prepositioned] even in facilities with pending cases” as long as they are licensed by the Department of Health, Morales said on Tuesday.

“Extraordinary times need extraordinary measures,” Morales said in a statement. “All transactions on IRM are aboveboard and within the guidelines set by the corporation.’’

‘Cash-slapping bonanza’

An internal audit report obtained by the Inquirer showed that IRM funds had found their way even to hospitals that either had pending cases with the state health insurer or were unaccredited and worse had no COVID-19 patients.

“So charitable was PhilHealth that it even extended its cash-slapping bonanza to unaccredited (hospitals) and even incorporated this fact in the IRM circular,” PhilHealth’s auditors said.

When PhilHealth announced the availability of IRM in March, it made clear then that “to mobilize as many health-care providers in the fight against the pandemic, even hospitals that are currently under sanctions due to certain violations may also apply.”

“This is not to say that they will no longer be penalized once proven guilty of any infraction of rules and policies. The whole point here is to ensure that we are able to help in making sure that as many facilities are open and able to serve patients,” Morales said.

No favored hospitals

The auditors also accused PhilHealth Senior Vice President Renato Limsiaco Jr., who heads the fund management sector, of supposedly having a hand in the release of P9.6 million to Catarman Doctors Hospital, a private hospital in Catarman, Northern Samar, that was slapped by the state insurer with an administrative case for violating its rules.

Morales belied the allegation that Limsiaco favored some hospitals or worked to release the funds in record time.

“[His] authority is limited to vetting the release of funds only in terms of completeness of documents, and not in determining which hospitals will be given the fund,” the PhilHealth chief said.

Subject to auditing rules

The amount to be released to hospitals under IRM is based on its historical claims. Hospitals that want to avail themselves of the fund, submit their applications to the PhilHealth regional offices, which will evaluate, validate and recommend their approval to the head office.

Contrary to allegations that no liquidation was needed, Morales said IRM was “strictly subject to the usual stringent government accounting and auditing rules, and requires reconciliation and liquidation.”

“Liquidation is definitely a must but since we are in unusual times, we made the timing of liquidation flexible with such options left to the good judgment of the regions given the situations that hospitals are in,” he said.

Morales earlier said the agency had already disbursed P14.5 billion to various hospitals through IRM.

The PhilHealth chief noted that it was “premature” for critics to say that hospitals in areas with low COVID-19 cases should not have been given access to IRM funds, reminding them that transmission of the coronavirus remained a threat.

“Remember that we have yet to contain the transmission. With [stranded people] returning home en masse, a spike in cases is still a very real possibility,” he said.

Second round

Amid the controversy surrounding IRM’s implementation, Morales said the state health insurer was evaluating a second round of IRM for hospitals in Metro Manila, Central Luzon, Calabarzon, Central Visayas and Eastern Visayas where full bed capacity had either been reached or was at critical levels due to the easing of quarantine restrictions.

PhilHealth said the allegations that Limsiaco “abandoned his post” to supposedly oversee Catarman Doctors’ operations were “unfounded” as the agency was able to release some P15 billion to 711 facilities.