PhilHealth: Medical coverage continues despite IRM freeze

The Philippine Health Insurance Corp. (PhilHealth) assured the public on Friday that it would continue to provide coverage to its members, including those who had been struck by COVID-19.

PhilHealth President and CEO Ricardo Morales sought to allay concerns that the release of benefit packages may be disrupted due to the investigations of the state insurance company by Congress, the Department of Justice, and Malacañang.

“Our offices are ready to serve our clients nationwide,” Morales said in a statement.

He added that since every Filipino is a PhilHealth member under the universal healthcare law, everyone will “continue to enjoy PhilHealth coverage for needed treatments and procedures.”

Concerns over a possible suspension of COVID-19 coverage followed PhilHealth’s announcement that it was temporarily halting the implementation of the interim reimbursement mechanism (IRM) “to review its overall implementation and resolve issues arising from congressional inquiries.”

The IRM is a special P30-billion fund for payments to hospitals and other medical facilities during times of calamities such as the ongoing COVID-19 pandemic.

Ricardo Morales

Not on hold

PhilHealth on Friday denied on its Twitter and Facebook accounts that the suspension of the IRM meant payments for coronavirus disease (COVID-19) cases would be put on hold.

“Contrary to one misleading headline today, PhilHealth is not suspending its COVID-19 payments for inpatient, testing, and community isolation packages,” PhilHealth said in apparent reference to the Inquirer.

“Affected patients are assured of continued entitlement to these benefits. What is suspended is the IRM for implementation review. The agency maintains that IRM is legal and necessary for the country’s overall COVID-19 response,” it added.

Sen. Panfilo Lacson, who set off the Senate investigation along with Senate President Vicente Sotto III, warned that the suspension of the IRM could be a ploy to pass the blame on the senators for PhilHealth’s failure to make payments.

“I’m sure that if the hospitals would ask them why they have not received [their payments], the PhilHealth officials would tell them that it was because the senators wanted to suspend [the IRM distribution],” Lacson told the Inquirer.

“They already did that ‘appeal to emotion’ when they said that senators do not care about the dialysis patients after we asked them why funds for COVID-19 were given to dialysis centers. They are skirting the issue by portraying us as heartless,” he said.

He said the suspension of the IRM would be “unfair to hospitals that are really qualified” to get the IRM funds.

Lacson surmised that PhilHealth officials agreed to halt cash advances as they had already provided funds to a select group of health facilities, including maternity clinics and dialysis centers.

Like Lacson, Sen. Joel Villanueva lamented that individuals who needed financial assistance might be unfairly affected by the suspension of the IRM and this could lead to the closure of some hospitals.

Panfilo Lacson —SENATE PRIB

Limited options

If that happens, more workers would end up jobless, he said.

“Our sick will have more limited options to seek treatment especially in this time of pandemic,” Villanueva said.

But he said “it is clear to us” that PhilHealth favored several hospitals by abusing the reimbursement mechanism.

Lacson and several other senators believe that IRM funds had been arbitrarily given to selected hospitals.

PhilHealth corporate counsel Roberto Labe Jr. said that was not true.

Lacson also doubted whether the remaining IRM fund was still intact, citing the disclosure by the Commission on Audit (COA) during the Senate probe that of the P14.9 billion already disbursed, only P1 billion had been accounted for.

Senate Majority Leader Juan Miguel Zubiri, who also exposed other irregular schemes in PhilHealth, said the moratorium on the IRM releases was a “good first step toward transparency.”

“This will allow COA and the Office of the Ombudsman to monitor and account for the earlier releases of the funds,” Zubiri said in a Viber message.

He said the release of large amounts of money from the IRM “without a clear disbursement program or budget request, especially to private companies, is highly irregular and prone to all sorts of corruption.”

This should be stopped until a “proper accountability system” is adopted, Zubiri said.