MANILA, Philippines — Two House committees on Tuesday approved the filing of administrative and criminal cases against Health Secretary Francisco Duque III and officials of Philippine Health Insurance Corp. (PhilHealth) for irregularities. The committees on public accounts and on good government and public accountability approved an 80-page report on their joint probe on the state health insurer.
The report included findings on the implementation of the all case rate, the interim reimbursement mechanism (IRM), the PhilHealth’s operation of an unauthorized payment system, the disadvantageous settlement of cases, fraudulent claims, adverse audit reports and other alleged irregularities.
In a Viber message to reporters, Anakalusugan Rep. Mike Defensor, public accounts committee chair, said the report also sought additional remedial legislation, such as removing the mandatory premium contributions for overseas Filipino workers, a PhilHealth Crisis Act granting emergency powers for the President to reform PhilHealth, and amendments to the Universal Health Care Act.
The Inquirer came out with an exclusive story of the committees’ findings contained in a draft report last week.
3 conditions
Marikina Rep. Stella Luz Quimbo, a member of the blue ribbon committee, proposed three conditions before the national government releases its P70-billion contribution to PhilHealth: a management audit report detailing policies and reforms to control fraudulent practices; a fund viability plan, including policies and reforms to increase premium collection rates and minimize risk of deficits; and a third-party review of PhilHealth.
During a hearing on Tuesday, members of the panels rejected a motion by Bulacan Rep. Jose Antonio Alvarado Sy, blue ribbon committee chair, to exclude members of the PhilHealth board from the charges.
The House joint panel will submit its report to the Department of Justice for further study.
The Senate committee of the whole had earlier recommended the filing of graft and malversation cases against Duque, former PhilHealth president Ricardo Morales and other senior executives for the release of IRM funds to health facilities not caring for COVID-19 patients.
Duque, as chair of the PhilHealth board, was held liable for the “flawed” mechanism of the IRM amid reports of preferential treatment for certain private health-care institutions; the operation of a PhilHealth payment system without authorization from the Bangko Sentral ng Pilipinas; and the board’s reversal of a court-affirmed suspension order against Perpetual Succour Hospital of Cebu Inc..
‘Not a signatory’
Duque decried the charges, maintaining that although he chaired the board, he was not a signatory to its resolution that paved way for the IRM in March as he was occupied as chair of the Inter-Agency Task Force for the Management of Emerging Infectious Diseases (IATF).
“They are implicating someone who didn’t sign [the resolution]. This is really an injustice. Why are they insisting [on this]? The truth of the matter is, Congress took away the voting right of the chairman so the chairman is a nonvoting member of the PhilHealth board,” he told the Inquirer.
Duque was referring to Republic Act No. 11223, or the universal health-care law, where the health secretary chairs the PhilHealth board as an “ex-officio nonvoting” member. The four other ex-officio members are the secretaries of labor, social welfare, budget and finance.
“On top of that I was absent, attending to my job as chair of the IATF. This was at the height of COVID-19, when we were expanding, ramping up our health system capacity,” Duque said.
He admitted that while the IRM’s objective was “good” as it aimed to help hospitals in their pandemic response, its implementation—which he stressed was management’s responsibility, not the board’s—was problematic.
“They’re saying that in the implementation, [funds were] used not for fortuitous events, for dialysis and other conditions … That will have to be determined by the courts, whether the inclusion of other conditions like dialysis and cancer cases should have been part of the application of IRM,” he said.
The House panels recommended that Morales be held liable for the implementation of the IRM, the unauthorized e-payment system, and the hiring of unqualified senior executives and changing the requirements for such positions.