PhilHealth IT system cannot detect fraudulent claims, says senior official

PhilHealth Senior Vice President and chief information officer Jovita Aragona during a Senate hearing on Tuesday, August 18, 2020. Photo from Senate PRIB

MANILA, Philippines — The current information technology system of the Philippine Health Insurance Corporation (PhilHealth) cannot detect fraudulent claims, one of its senior officials said Thursday before members of Task Force PhilHealth.

Justice Undersecretary Markk Perete, in a statement, said: “[Senior Vice President and Chief Information Officer Jovita] Aragona admitted to the inability of the current IT systems of PhilHealth to detect fraudulent claims.”

Aragona, one of the resource persons invited by the panel said there are segments in the corporation’s validation processes that are still done manually.

“She attributed the current lack of validation mechanism in the corporation’s IT systems to the alleged failure of its relevant offices to specify their required internal control systems during the design and development of the IT systems. She likewise bared the corporation’s plans to develop a more sophisticated IT system in the future,” Perete said.

Aragona also told panel members that the previously reported questionable procurement of switches was a transaction of the PhilHealth National Capital Region office.  She called for an investigation to be conducted on the said office.

Aside from Aragona, other invited resource persons from PhilHealth are Corporate Secretary Jonathan Mangaoang and Acting Senior Manager of PhilHealth’s Fact-Finding Investigation and Enforcement Division (FFIED) Ernesto Barbado.

Mangaoang said that the controversial Interim Reimbursement Mechanism (IRM) was proposed in January 2020 to ensure that hospitals and medical establishments remain financially viable in case of emergencies and fortuitous events.

He noted that the PhilHealth Board approved the IRM based on an opinion issued by the corporation’s Legal Sector.

The IRM has already been suspended following reports of favoritism in the disbursement of funds under IRM.

Mangaoan said the Board has approved the recommendation by the corporation’s Protest and Appeals Department to grant amnesty to hospitals that belatedly filed claims for reimbursement from 2011 onwards.

“The law that created PhilHealth renders ineligible for reimbursement a claim filed beyond sixty (60) days from the discharge of a patient,” the. statement read.

Barbado, on the other hand, asked the Task Force to look into a certain ghosts or fake claims previously investigated by the Fact-Finding Investigation and Enforcement Division (FFIED).

Justice Secretary Menardo Guevarra is the head of the high-level, inter-agency task force created by President Rodrigo Duterte. The task force has 30 days to submit its findings.

JPV