PhilHealth to rectify IRM after being questioned why dialysis and maternity clinics included

Health Secretary Francisco Duque III on Tuesday said PhilHealth will rectify the interim reimbursement mechanism (IRM) which includes dialysis and maternity centers in facilities that are only supposed to cover COVID-19 centers.

"We will rectify this," Duque said, when he was questioned why dialysis and maternity clinics were included in the IRM, which is supposed to cater only to "fortuitous events."

Duque also serves as chairman of the PhilHealth Board of Directors.

The IRM is a system where the PhilHealth pays hospitals and healthcare facilities in advance for insurance claims, to ensure that they could function in crises.

PhilHealth defines the IRM as "a special privilege for the provision of substantial aid to an eligible Health Care Institution (HCI) directly hit by fortuitous event with clear and apparent intent to continuously operate and/or rebuild the HCI in order to provide continuous health care services to adversely affected Filipinos."

The state insurer has maintained that the IRM is not only for COVID-19 patients, but acts as an overall response to the pandemic.

But on Tuesday, Senator Panfilo Lacson questioned why dialysis and maternity clinics were covered by the IRM when they should be covered by the regular programs of PhilHealth.

"Fortuitous event ba ang dialysis?... Maternity care?" Lacson asked Duque.

"Regular benefit claims 'yang sinasabi ninyo na hindi tatama dito sa Circular na nilabas... Hindi naman natin inaalis na tulungan din, pero sa ibang program. Hindi dito," said Lacson.

According to Lacson, the IRM under Circular 2020-0007 only covers fortuitous events, in this case the coronavirus pandemic, and not supposed to cover dialysis and maternity clinics.

"Maski hanapin ninyo buong maghapon, wala kayong makikitang pang-justify na saklaw ng IRM, partikular na doon sa Circular 2020-0007, na puwedeng sakupin ang non-COVID-19 cases," he said.

"Wala po kayong makikita, maski maghapon, maski isang linggo kayong maghanap, wala kayong makikita," he added.

Under its mandate, PhilHealth is tasked to administer the National Health Insurance Program which aims to provide health insurance coverage and ensure affordable, acceptable, available and accessible health care services for all citizens of the Philippines.

In a previous Senate hearing, resigned anti-fraud officer Thorsson Montes Keith claimed that the PhilHealth "mafia," composed of the executive committee, stole some P15 billion through fraudulent schemes such as the IRM.

PhilHealth, in a statement, has since denied such claims.

The IRM has since been suspended by PhilHealth, amid issues hounding the payment system. — RSJ, GMA News