MANILA, Philippines — Anakalusugan Partylist Rep. Mike Defensor has proposed the filing of charges against all officials found involved in so-called mafia in the Philippine Health Insurance Corp. (PhilHealth).
During the joint hybrid hearing of the House committees on good government and public accountability, as well as public accounts, the lawmaker said the billions of pesos lost in PhilHealth due to corruption is tantamount to plunder.
Defensor, citing reports from the Commission on Audit (COA) and PhilHealth, pointed out the questionable surge in the number of claims in various health cases such as pneumonia and hemodialysis through the years.
“To the PhilHealth, this is the scheme ng sinasabing mafia. Because we know on the regional level, meron kayong tinatawag na benefits claim committee,” Defensor said.
“At dahil may case rate setup, ibibigay na lang ‘yun sa finance. Pagdating sa finance, walang tanong-tanong dahil submitted ng region, babayaran agad. At pagdating diyan, lalabas na ang pondo sa mga ospital,” he added.
Defensor then questioned why transactions related to benefit claims are faster in private hospitals than in government hospitals.
“’Yung mga ospital natin particular ang mga government hospitals, ang tagal ng bayaran. Dahil ba dito sa scheme ng sinasabing mafia, na kapag may usapan sa isang region o ang regional officer sa isang ospital at may usapan sa taas, mabilis ang nagiging bayaran?” the lawmaker asked.
With this, Defensor proposed that charges be filed against PhilHealth officials proven to be involved in the alleged scheme, saying that charges should also cover those in the regional levels.
“And I submit to the members of this committee, this, in fact, is plunder. Yung bilyon-bilyong nawala ay plunder,” Defensor said.
“At ang aking rekomendasyon ay kasuhan hanggang sa regional level dahil lalabas diyan sinong ospital ang nakinabang, sinong kakuntsaba, dahil malinaw naman ang records ng COA at madali itong imbestigahan,” he added.
In an earlier hearing, Defensor said that PhilHealth lost an estimated P153.7 billion from 2013 to 2018 due to overpayment and fraud.
Defensor said that computed conservatively at 20 percent as set by COA, the state-run health insurer has lost P102 billion due to overpayment.
Computed at 10 percent, Defensor added, PhilHealth has lost P51.2 billion due to fraud.