MANILA, Philippines — A lawmaker hit what she called a “systematic anomaly” in the Philippine Health Insurance Corp. (PhilHealth) involving the reimbursement of COVID-19 swab tests already paid for personally by its members.
Bagong Henerasyon Partylist Rep. Bernadette Herrera said she has received numerous reports where PhilHealth members who underwent tests but did not avail of the COVID-19 testing benefit package of the state-run insurance agency were still asked to provide their PhilHealth identification number.
“Once provided, a hospital or testing center then processes a reimbursement against that person’s PhilHealth account, and the money is pocketed by these unscrupulous individuals,” Herrera said on the plenary floor.
Herrera added that her brother, Quezon City Councillor Bernard Herrera, nearly fell victim to the alleged PhilHealth reimbursement scheme.
The lawmaker said her brother received a text message from the billing department of the Pampanga hospital which processed his COVID-19 polymerase chain reaction (PCR) test, asking for his PhilHealth account number.
“This is one hospital, out of so many that are capable of doing this. The magnitude of this anomalous scheme is beyond comprehension. This is so systemic, so complicated, that it cannot have been done without complicit actions of people within PhilHealth,” Herrera said.
Herrera said she has asked the Department of Health and the PhilHealth to investigate the matter, which she also referred to as “syndicated corruption” for “exploiting the emergency of the pandemic to steal from the health fund.”
“I have asked DOH (Department of Health) and PhilHealth to investigate. Now, I am asking Congress to do the same,” Herrera said.
“It is high time your corrupt ways end and your days are numbered,” she added, referring to those involved in the scheme.
‘Severe lack of public information’
Herrera pointed out the severe lack of public information that certain sectors in the country are allowed to have COVID-19 tests for free.
The lawmaker was referring to the six subgroups of at-risk individuals that are given priority for free COVID-19 testing, as identified by the DOH.
This includes patients with severe symptoms and mild symptoms but with travel history or contact, health care workers, senior citizens, and returning overseas Filipino workers (OFWs).
Also identified to undergo regular free PCR test are workers in the tourist zones, local manufacturing companies, transport and logistics, food retail, education, financial services, non-food retail, services, public market, construction; water supply, sewerage, and waste management; public sector, and mass media.
“One, therefore, asks, how many of us even knew that our mothers and fathers, our market vendors, our OFWs, among many other categories, could claim a package for the PCR tests and not have to shell out any much-needed cash?” Herrera said.
“Why was it that this system was not fully publicized if the intent was to allow for qualified people to get tested at the very least without the brunt of paying full price?” she added.
Citing PhilHealth’s own records, Herrera said the state health insurer has a budget between P27.88 billion and P29.77 billion for 10.12 million COVID-19 tests. However, she said only 2.39 percent of the total number of tests have been done and 9.6 percent has been spent by PhilHealth out of its total budget for test claims.
As of last August 17, Herrera said a total of 105 testing centers are accredited under this system, with 42 in the National Capital Region alone. In its report dated September 4, PhilHealth said only 11,416 claims were paid prior to June 25 and a dismal 1,152 claims were paid after that same date.
“Are we now to believe that a total of 12,571 tests were paid for? That only 72,189,498 pesos were actually paid out thus far?” Herrera asked.
“May 105 kayong accredited hospitals and testing centers, pero hindi nagagamit ang budgeted amounts. Bakit kaya? The answer is the syndicated corruption that is plaguing the country, from both private hospitals and centers, empowered by the good-for-nothings within PhilHealth,” she added.