PhilHealth exec said current IT system can't detect fraudulent claims —DOJ

An official of the Philippine Health Insurance Corp. (PhilHealth) has told investigators that the state insurer's information technology (IT) systems are unable to detect fraudulent claims, the Department of Justice (DOJ) said Thursday.

In a statement, Justice Undersecretary Markk Perete quoted Senior Vice President Jovita Aragona as telling Task Force PhilHealth that parts of the corporation's validation processes are still done manually.

Aragona also claimed that the relevant offices failed to specify their required internal control systems when the IT systems were being developed, Perete said.

"She likewise bared the corporation's plans to develop more sophisticated IT systems in the future," the DOJ official said.

PhilHealth chief Ricardo Morales earlier said an improved IT system would help address corruption in the corporation. He said the insurer is investigating around 20,000 fraudulent claims.

Task Force PhilHealth, which was formed to investigate allegations of corruption in the agency, held its second hearing on Tuesday.

The task force has agreed to set up teams to "thoroughly" investigate the IT and legal sectors of PhilHealth, Perete said.

Perete added that Aragona called for an investigation on PhilHealth's National Capital Region Office, which she claimed was the unit that entered into an allegedly anomalous procurement of network switches.

Corporate Secretary Jonathan Mangaoang and Acting Senior Manager of PhilHealth’s Fact-Finding Investigation and Enforcement Division (FFIED) Ernesto Barbado also testified at the task force's hearing, Perete said.

He said Barbado asked the task force to look into fake claims being investigated by the FFIED.

Mangaoang, for his part, explained that the purpose of the controversial interim reimbursement mechanism (IRM) was to ensure that hospitals and medical facilities remained financially viable in case of emergencies and fortuitous events, Perete said.

Mangaoang also said that the PhilHealth's board of directors has approved a recommendation to grant amnesty to hospitals that belatedly filed claims for reimbursements from 2011 onwards.

Both the Senate and the House of Representatives have conducted lengthy hearings to look into alleged anomalies at the state insurer.

The Senate has wrapped up its investigation and is drafting its initial report.

Justice Secretary Menardo Guevarra formed Task Force Health upon the order of President Rodrigo Duterte. It is composed of the Office of the Ombudsman, the Commission on Audit, the Civil Service Commission, and the Office of the President, with the National Bureau of Investigation and the Anti-Money Laundering Council for support. —KBK, GMA News