The PhilHealth anomaly: Where’s Our Money?

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If the revelation of former PhilHealth anti-fraud chief Atty. Montessa Keith, the whistleblower, that Philippine Health Insurance Corporation (PhilHealth) top officials have amassed wealth from people’s contribution to the agency is true, then, how else do we get through the bottom of this mess amid the ongoing health crisis?

Keith revealed the anomaly at PhilHealth has been going on for several years saying top officials of the agency squandered insurers’ money to the tune of P15-billion.

For a job order employee who contributes P400 monthly from his hard-earned money for health insurance, it is more than robbery- they are legally paying for the crooks inside a government agency.

If a contributor fails to pay in three consecutive months prior to his hospitalization, he cannot avail of the PhilHealth benefit, and thus, he needs to shell out from his pocket for his bill as PhilHealth wouldn’t care.

In most PhilHealth regional offices, contributors awaits a shabby treatment from run around to come back another time. This toxic treatment is adding insult to every injury to their contributor, whose money were snatched inside an air-conditioned office. 

The victims

The “mafia” at PhilHealth did not only siphoned government money but also the hard-earned money of the Overseas Filipino Workers (OFWs) and their families.

Former PhilHealth auditing system specialist Ken Sarmiento during the hearing conducted by the House Committee on Good Government and Accountability revealed his former office has identified at least 2,726,453 Overseas Filipino Workers (OFWs)  and their dependents from 2015 to 2017 alone who lost their contributions due to “damaged, canceled, or lost” receipts.

Sarmiento said the cumulative losses from the OFWs premiums amounted to ₱1.3 billion, were all because of the fraudulent scheme the agency adopted.  During his term at PhilHealth, he said he coordinated with the  Philippine Overseas Employment Administration.

He cited the so-called  “sharing scheme” exists between representatives of hiring agencies and “marketers” who sell fake PhilHealth receipts to victimize OFW members.

There were thousands of “bogus” and recycled receipts issued to the recruitment agencies and the control numbers were picked from different PhilHealth regional offices. The modus exits before he was appointed to office in 2015.

He revealed, ”Control numbers [of the receipts] were sourced from different areas of the country, from as far as Batangas, Pampanga, Iligan City”  in Mindanao.

In different regions, OFWs have raised the complaints but it fell into the deaf ears of PhilHealth officials.

As of 2018, at least 48 land-based hiring agencies were under investigation, 12 of which have affidavit complaints filed with the National Bureau of Investigation.

The Players

In early August, PhilHealth spokesperson Dr. Shirley Domingo admitted that a number of physicians and hospitals are indeed involved in fraudulent schemes and transactions with the state health insurer as earlier revealed by the task force investigating the agency.

“As to doctors and hospitals, totoo po ‘yun, nilalabas na namin for these past years,” said PhilHealth spokesperson Dr. Shirley Domingo in an interview on ABS-CBN Teleradyo. Saying “Meron po talaga. May mga nahuli na kami,” she said, adding that cases have been filed against involved individuals.

Domingo’s statement coincided with the statement of Santiago who said that the syndicate inside PhilHealth has more than 40 members scattered all over the country and in cohorts with some willing professionals, hospital, and medical practitioners.

“We discovered about 40 plus of them and we documented about 12 to 13, so fair to say na merong pang sindikato (that there is a syndicate behind this),” said Sarmiento. He did not say if it is connected to the “mafia” syndicate within PhilHealth which has been the target of congressional probes over the past weeks.

As of 2018, at least 48 land-based hiring agencies were under investigation, 12 of which have affidavit complaints filed with the National Bureau of Investigation.

But wait, recent development as revealed by former PhilHealth anti-fraud chief Atty. Montessa Keith, top officials of the agency squandered insurers money to the tune of P15-billion and the crime has been repeatedly committed for years.

Worse, the Senior Vice President of the agency feared, that the agency will operate on a red budget come 2021, because prior years’ fund has been spent due to the anomalous releases of IRM.

The modus 

The IRM is a system of giving hospitals and clinics cash  to use during “fortuitous events”  like the pandemic.

As of June 9, PhilHealth had released more than P14 billion under the IRM to different hospitals and clinics all over the country – when it should have taken effect only on June 11. In short, P14 billion was paid out illegally.

Based on the documents gathered by Senator Vidente Sotto, the Senate majority Floor Leader, he identified Neurologist Dr. Mark Dennis Menguita of Region 12 as among the players.

Menguita reportedly recruits patients and offer a free overnight check-up at the Allah Valley Medical Specialist Inc. in South Cotabato and made them sign documents relative to their confinement.

But unknown to the patients, their simple headache or fever turned out as a major neurological problem, giving Menguita the right to charge exorbitant fees for the confinement and refund the same in cahoots with his insiders at the PhilHealth.

Sotto revealed, “This doctor will connive with the hospital where he is affiliated with, particularly St. Louis Hospital, Allah Valley Medical Specialist Hospital, Inc., Arturo Pinggoy Medical Center and St Louis Medical CL and Hospital in order to collect from Philhealth for the supposed expenses incurred by the hired Philhealth members. The collected amount will then go to neurologist’s pocket, his own pocket, and maybe the hospitals get their share, fair share”. 

Another major anomaly identified during the Senate investigation was the alleged bloating of PhilHealth’s proposed information technology (IT) budget for 2020.

Alejandro Cabading, a member of PhilHealth’s board of directors, told the Senate that items on the IT department’s proposed P2.1-billion budget had amounts significantly larger than what was recommended by the Department of Information and Communications Technology (DICT).

In total, Cabading said the proposed IT budget was P734 million more than what it should have been, based on the DICT’s recommended information systems strategic plan for the state insurer.

Some items on the proposed budget were decidedly vague and redundant, such as two entries for “laptops,” one worth P115 million and another, P4 million. The entries did not specify the number of laptops to be procured.

 Duterte’s order

Ricardo Morales, the resigned president and CEO of Philhealth is not yet off the hook, according to President Rodrigo Duterte. His resignation will not stop the probe and he even order newly appointed PhilHealth President and CEO Retired National Bureau of Investigation Director Dante Gierran to cleanse the office.

On September 1, Duterte introduced Gierran during the Inter-Agency Task Force for the Management of Emerging Infectious Disease Meeting.

In introducing Gierran, Duterte said  “I introduce you to the new PhilHealth (president), Gierran, he is the retired director of the NBI… He is a lawyer and an accountant”.

Duterte further added, ”I told him the next two years will be devoted to fight against corruption. Find people we can send to jail. Para may maiwan tayo sa kulungan”

Gierran was given the marching order to reshuffle in PhilHealth in two to three days and to remove all regional vice presidents. He said he would also order a reshuffle at the NBI and Bureau of Customs.

Gierran vowed to restore the people’s trust and confidence in PhilHealth. He said he must improve the services and address the perennial issues of corruption in the agency.

He admitted he had been listening to the congressional hearings on the alleged irregularities in PhilHealth and was “really aghast” about the sorry state of the agency – “corruption here and there.”

He considers his new job as a “huge mission” and is consoled by the fact that there is support being extended to him.

Morales, who is suffering from lymphoma, stepped down from his post as PhilHealth undergoes scrutiny over alleged anomalous schemes that defrauded the state insurer of billions in funds. PhilHealth officials have denied involvement in irregularities and have vowed to cooperate with the investigation.

With all the anomalies reported and order s from Duterte, Gierran is left with no choice but to cleanse the agency and deliver what is expected on his promise.

Be informed
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