Go demands truth on PhilHealth fraudulent claims

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MANILA –“The people deserve to know the truth and the seated officials must provide solutions, not excuses,” said Senator Christopher Lawrence “Bong” Go during the Senate inquiry on Wednesday.

The Senate investigated on the alleged anomalies involving the Philippine Health Insurance Corporation (PhilHealth).

“Kailangang malaman ng Senado at ng taumbayan ang katotohanan sa isyung ito. Interes ng bawat Pilipino ang dapat manguna,” Go said.

The Senate Committee on Health, which Go chairs, and the Senate Blue Ribbon Committee, headed by Sen. Richard Gordon, are conducting a joint investigation on the alleged fraudulent claims that PhilHealth granted to certain health care facilities and providers, including WellMed Dialysis and Laboratory Center (WellMed).

WellMed, based in Quezon City, allegedly filed falsified benefit claims with PhilHealth on behalf of deceased patients, receiving at least P800,000 using this scheme.

Go questioned past and present PhilHealth officials on how the claims were able to pass through several stages of review.

“May submission of claims and then adjudication by benefits. May administration sector, so dadaan at i-tse-check ninyo, then medical review by doctors, i-tse-check ninyo, and then payment approval. Puro po ito sa PhilHealth, so bakit po nakakalusot itong mga up-casing, itong mga overpayment, itong fraudulent claims?” the Senator asked.

Gilda Diaz, PhilHealth’s vice president for the National Capital Region, admitted that the claims system of the state-run corporation failed to detect the anomalies. “Yung sinasabi po nilang ghost claims po, hindi ho talaga siya na-detect sa claims system namin.”

She said that her office only learned of the case when the investigation was done and PhilHealth had to withdraw WellMed’s accreditation.

“The (PhilHealth Regional Office) NCR was not also informed of the whistleblowers, of the investigation going on. We learned about the fraud activities only in late January po, when the fact-finding investigation and the Enforcement Department informed the Accreditation Department, kasi hiniling po namin na ma-withdraw po ang accreditation ng WellMed,” she said.

“That is the time when we learned of the fraud activities po. The (PRO NCR) recommended the withdrawal of the accreditation to the head office,” she added.

Go asked the same question to Dr. Roy Ferrer, who served as PhilHealth acting president and CEO from June 2018 to June 2019.

“Dr. Ferrer, paano nalusutan? Pakisagot. Paano nalusutan? Ang daming layer po na dinadaanan. Bakit po nalusutan, at meron bang kuntsaba with PhilHealth officials?” Go asked.

Ferrer cited the lack of health care professionals to check the claims as one reason.

“Ang kulang po natin ay talagang mga doctors na nasa field to check. Not necessarily doctors but health professionals. In fact, during my time, I even asked nurses to be trained so that they will be able to know whether these claims are valid and there is a reason for (the patients) to be admitted or not,” Ferrer said.

But Ferrer also admitted that corruption exists within the ranks of PhilHealth. “We cannot deny that some of our employees are in cahoots (with private hospitals).”

The answer incensed Go, and he challenged former general Ricardo “Dick” Morales, the newly appointed PhilHealth president, to address the problem.

Go also said that he would not take sides and would remain true to his oath as a senator. “Wala po akong kinikilingan. Kahit kaibigan o dating katrabaho ang sangkot, kahit na tumulong noong kampanya, kahit nagpapawis noong kampanya sa amin, gagawin ko ang nararapat. Tutuparin ko ang aking sinumpaang tungkulin,” Go added.

The Senator was also disappointed over how health care officials address corruption issues. “Matagal na pong issue ito. Noon pang 2015, nag-hearing na ang Blue Ribbon tungkol sa fraudulent claims, subalit hanggang ngayon, patuloy ang mga illegal na gawain sa PhilHealth. Tuwing mayroong anomalya o kontrobersya, puro rason, puro palusot ang naririnig natin. Ang gustong marinig ng taong bayan, solusyon naman.”

He added that the anomalies must stop, echoing President Rodrigo Duterte, and urged the Department of Justice to refile the case against WellMed, which allegedly claimed payments from PhilHealth for “ghost” dialysis sessions and patients.

“Hindi na dapat magpatuloy ang anomalya sa Philhealth. Sabi nga ng ating Pangulo, hindi tayo papayag—not even a whiff of corruption. Dapat managot ang dapat managot. Sa kaso ng WellMed, I urge the DOJ to refile the case (with) the appropriate court at palakasin pa ang kaso para siguradong may mapaparusahan,” Go said.

The Quezon City Regional Trial Court recently dismissed the case for “lack of jurisdiction.”

Go urged PhilHealth to clean up and fix its systems in preparation for the implementation of the Universal Health Care Law. “Next year is the first year of the implementation of the Universal Health Care Law. Around P250 billion po ang funding requirement nito. Bago pa man ma-implement ito, linisin na natin ang PhilHealth.”

He expressed his trust on the newly installed officials of the government-owned and controlled corporation. “Malaki po ang tiwala ko sa pamunuan ng bagong PhilHealth headed by (former) general (Ricardo) ‘Dick’ Morales at sa mga bagong board members.”

He also reminded officials that the money being spent on health care comes from the people and should be spent for the people. “Ang pasyente ay hindi dapat nagmamakaawa sa atin para sa tulong dahil pera nila yan. Pera ‘yan ng taong bayan. They deserve quality health service mula sa ating health officials. Ang hirap at sakit po isipin na nawawala at nasasayang lang ang pondo natin para sa health care dahil sa korapsyon.” (With reports from PR)

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