PhilHealth cleaning up database with PSA’s help

The COA said in a report released last week that it found 8,156 deceased senior citizens still in PhilHealth’s database. —CONTRIBUTED PHOTO

MANILA, Philippines — The state health insurer on Saturday said it was getting help from the Philippine Statistics Authority (PSA) to clean up its database after a government audit report said that deceased elderly members remained in its database.

Philippine Health Insurance Corp. (PhilHealth) also said it would give the Commission on Audit (COA) full access to documents on the “unsubstantiated” payment of P3.375 billion it had made for COVID-19 tests.

The COA said in a report released last week that it found 8,156 deceased senior citizens still in PhilHealth’s database.

Of the 8,156 deceased elderly, 4,544 died in 2019, but they were still included in the 2020 billings to the Department of Budget and Management (DBM), which resulted in an “oversubsidy” of PhilHealth premiums of at least P22.72 million.

State auditors believe that the number of deceased elderly members still in the database and the resulting overpayments could be bigger because current figures are based on reports from only 1 percent of 1,201 PhilHealth-accredited hospitals that responded to the COA’s request for a list of patients who have died.

Spox assures COA

PhilHealth spokesperson Shirley Domingo assured the COA and the public that efforts were under way to update its database.

“We have signed a memorandum of agreement (MOA) recently with the PSA to share data on deaths so we can clean our database on this issue,” she told the Inquirer in a reply to a request for comment on the COA’s report.

Domingo explained that “unless reported to us by their relatives, we don’t have a way to monitor deaths unless the data is shared with us by other government agencies that capture this data.”

The COA noted that PhilHealth and the PSA signed their MOA on June 28, saying the agreement would help “data match the membership database, both members and dependents, with the PSA death registry.”

In 2020, PhilHealth billed the government P31.177 billion for the premiums of 6,235,438 enrolled senior citizens at P5,000 each.

Under Republic Act No. 11223, or the universal health care law, the government would subsidize members who have no capacity to pay their premiums.

Responding to the reportedly unsubstantiated payments for 950,144 COVID-19 tests under a contract with the Philippine Red Cross, PhilHealth assured the COA that it would give the audit body access to all case information forms (CIFs) from the contractor so that state auditors could ascertain the propriety of the payment claims.

The contract with the Red Cross was under PhilHealth’s interim financing mechanism (IFM).

The COA said that payments were made even though the CIFs contained blank fields or incomplete details, apart from inconsistencies and deficiencies in the validated list or summary of test results.

CIFs are documents containing the personal information of a person who has been tested for COVID-19. These forms are submitted to the DBM by PhilHealth in order for the contractor to collect the payment for its services.

The tests done used the reverse transcription-polymerase chain reaction (RT-PCR), which is preferred by the Department of Health (DOH).

State auditors said the disbursements amounting to a total of P3.375 billion did not conform with the provisions of the IFM, and issuances of the DOH and PhilHealth itself.

The COA warned that the fund releases could be considered “unsubstantiated claims,” a violation of the Government Auditing Code.

Domingo said PhilHealth had “discussed submission of DOH requirements with Red Cross prior to our payment.”

According to the COA report, PhilHealth conducted a revalidation of the claims for test payments and identified 5,374 with deficient records.

As a result, “adjustments amounting to P18.809 million have already been deducted from the outstanding payables to the contractor for these claims.”