Ex-PhilHealth chief says probe should focus on hospitals, other sources of fraud

MANILA, Philippines — Former Philippine Health Insurance Corp. (PhilHealth) president Ricardo Morales on Tuesday said investigations seem to be “looking the wrong way” as hospitals and professionals are mostly involved in cases of fraud and violations.

“There are 20,000 cases of violations and possible fraud in our dockets, in the regions and central office. You know where the corruption is happening? They’re looking the wrong way. It’s in the hospitals,” Morales said in an interview over ABS-CBN News Channel.

“The hospitals receive the money. Almost all the cases of fraud or violations, not almost, all, are in the hospitals and the professionals. That’s where to look,” he added.

Previously, Morales said he received reports that some hospitals misreport coronavirus disease (COVID-19) cases, supposedly in a bid to claim high reimbursement from the state insurer.

Morales said the newly appointed PhilHealth chief former National Bureau of Investigation director Dante Gierran could have an “advantage” by tapping external resources in probing the supposed irregularities of the state insurer.

“I think Director Gierran will have an advantage since he can use external sources to do this investigation. Pag ginamit mo internal [resources], collusion yan, magtatakipan lang. It will not be very useful,” Morales said.

The release of funds to hospitals under PhilHealth’s Interim Reimbursement Mechanism (IRM) was among the alleged irregularities probed by Congress and the task force led by the Department of Justice.

Also being investigated are its “overpriced” P2-billion information technology project and alleged manipulation of PhilHealth’s financial records.

EDV