PhilHealth urged to 'withdraw' policy including suspected, probable cases in COVID packages

The House joint panel conducting inquiry into the alleged irregularities at PhilHealth on Thursday adopted a motion urging the agency to "withdraw" its policy that includes suspected and probable cases in its COVID-19 packages.

The motion came after Marikina City Representative Stella Quimbo questioned the inclusion of suspected and probable COVID-19 cases in PhilHealth case rates.

"Sa aking pagkakaalam, dahil wala na ring backlog sa testing, ayon sa DOH (Department of Health), by the time ma-discharge ang isang patient, and upon discharge inaawas ang PhilHealth reimbursements, dapat wala nang suspect or probable kasi nakalabas na ang test results by that time," Quimbo said.

"So hindi na dapat ia-allow ng PhilHealth ang pag-reimburse ng cases para sa suspected [and probable]," she added.

House Committee on Public Accounts chair Mike Defensor turned Quimbo's manifestation into a formal motion.

The motion, according to Defensor, was to "strongly urge PhilHealth to withdraw the policy for suspected and probable COVID cases as part of their circular and resolution approved by the board."

"If there is no objection, motion is carried," he said.

PhilHealth senior vice president Dr. Israel Pargas agreed with the adopted motion of the House joint panel.

"Technically under review naman nga siya para ma-check yung kasama yung suspect and probable kasi nung una kasama nga siya," he said.

IRM

Apart from the inclusion of suspected and probable cases in PhilHealth case rates, Quimbo also questioned the application of the controversial interim reimbursement mechanism (IRM) on cases of COVID-19.

Citing PhilHealth circular 2020-0007, Quimbo pointed out that the IRM was devised only to respond to "fortuitous events."

"Dalawa lang ang fortuitous events dito: act of God [and] act of man... resulting in the destruction of the health sector, nang sa gayon kailangan talaga maglagay ng malaking pondo sa mga ospital para mapabilis ang pag-repair at masiguradong may access to healthcare ang ating mga kababayan in this situation," she said.

"So sa aking palagay, hindi applicable yung konsepto ng IRM dito sa COVID kasi wala namang nasira na ospital. So yun ang aking pinagtatakahan," she added.

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.

The 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."

Pargas insisted that the IRM was designed not only for facilities or structures but also for  the operation of healthcare systems.

"Ito naman is to make sure that the facilities can actually respond and provide continuous access to care and health provision to all our patients pero hindi siya limited only for COVID cases but even indirect effects na nandun din sa scope ng circular," he said.

Quimbo seems dissatisfied with Pargas response, saying it seems like the PhilHealth executive committee only got lazy to come up with a new mechanism to expedite the reimbursements for COVID-19 cases.

"Sa tingin ko talagang nangyari dito ay tinamad na lang ang execomm. Tinamad na lang ang head office na mag-isip ng mekanismo na appropriate for purposes of expediting reimbursements para sa ating COVID patients," she said.

"Imbes na gumawa na lang ng isang special lane or an expedited claims processing para sa COVID, in-apply na lang itong IRM. At ang mahirap diyan, since wala silang tiwala sa regional offices... pinark na lang nila itong napakalaking pondo sa mga ospital," Quimbo added.

PhilHealth earlier announced that it has suspended the IRM "to review its overall implementation and resolve issues arising from Congressional inquiries.

"PhilHealth vowed to find ways to make the IRM more responsive to the needs of healthcare facilities affected by the current pandemic to assure patients of continuous access to needed health services," it said.

Resigned PhilHealth anti-fraud officer Thorsson Montes Keith earlier claimed that the PhilHealth "mafia," composed of the executive committee, stole some P15 billion through fraudulent schemes, including those involving the IRM.

PhilHealth, in a statement, has since denied such claims. —KBK, GMA News