Hospitals with fraud cases received P1.49 B from PhilHealth’s IRM – solon
MANILA, Philippines — Anakalusugan party-list Rep. Mike Defensor questioned Monday why the Philippine Health Insurance Corp. (PhilHealth) still released Interim Refund Mechanism (IRM) funds amounting to P1.49 billion to 51 hospitals with fraud-related offenses.
During the joint hybrid hearing by the House of Representatives’ Committee on Public Accounts and the Committee on Good Government and Public Accountability, Defensor pointed out that a total of P1,493,554,124 IRM funds were released to the said hospitals.
“Itong 51 hospitals na ito ay may fraud cases na binigyan ng IRM… Bakit hindi ni-resolve ang fraud cases bago nag-release ng IRM?” Defensor asked.
(There are 51 hospitals with fraud cases that benefited from the IRM. Why were the cases not resolved first before IRM funds were released to them?)
IRM is an emergency cash advance measure of PhilHealth to provide hospitals with an emergency fund to respond to natural disasters, calamities as well as other unexpected events.
“Kasi sa mata ng publiko, sa mata namin, kung ganito na may mga fraud cases ang mga ospital at institusyon at bibigyan pa rin ng pondo ng PhilHealth, nakakatakot ‘tong batayan, nakakatakot itong ehemplo,” the lawmaker added.
(It is a scary basis and example if hospitals facing cases of fraud receive money from the IRM.)
Defensor argued that hospitals with fraud cases should not benefit from IRM funds.
Citing documents submitted by PhilHealth, Defensor said that there are 4,664 fraudulent cases reported from 2013 to 2020.
Offenses committed by healthcare institutions include padding of claims, claims for non-admitted or non-treated patients, extending period of confinement, post-dating of claims, misrepresentation by furnishing false or incorrect information, and unjustified admission beyond accredited bed capacity.
Other offenses also include unauthorized operations beyond service capability and fabrication or possession of fabricated forms and supporting documents.
PhilHealth has insisted that its IRM was “legal and necessary” for the country’s COVID-19 response.
The state health insurer on Thursday announced the suspension of the IRM after several senators called for its temporary halt amid allegations that the release of funds for the country’s coronavirus response was marred with irregularities.
