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House panels recommend charges vs. Duque, Morales over PhilHealth mess


Two House committees on Tuesday formally recommended the filing of charges against several government officials, including Health Secretary Francisco Duque III and former PhilHealth chief Ricardo Morales, in connection with the alleged anomalies in the state health insurer.

The House committees on public accounts and on good government and public accountability, in its joint meeting, adopted their panel report on their investigation in the PhilHealth issue, which contains the recommended charges against Duque and other officials involved in PhilHealth.

Among the issues that the officials were recommended to be charged for are the anomalous implementation of the interim reimbursement mechanism (IRM) and the supposed irregularities involving the PhilHealth's IT system.

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

However, throughout the course of the congressional investigations, it was found that IRM funds were also transferred to dialysis centers, infirmaries, and maternity centers even as they could not be considered as responding to "fortuitous" events.

"While the idea behind the IRM may be commendable, the mechanism itself is flawed and encourages large scale corruption and collusion between PhilHealth officials and HCIs," the panel report read.

"While the program uses the term reimbursement, the IRM is actually a cash program the legal basis of which PhilHealth has failed to provide this investigative body," it added.

For this issue, the joint panel recommended the filing of charges for graft and technical malversation against Morales, PhilHealth Executive Vice President Arnel de Jesus, Senior Vice Presidents Israel Pargas, Renato Limsiaco, former SVP Rodolfo del Rosario Jr., and Senior Manager Rogelio Pocallan Jr.

Also recommended charged over the IRM issue are PhilHealth board members who are also Cabinet officials, namely Duque, Labor Secretary Silvestre Bello III, Budget Secretary Wendel Avisado, Social Welfare Secretary Rolando Bautista, and Finance Secretary Carlos Dominguez III.

However, it is still unclear if the board members are recommended charged for the same violations, as House public accounts chair Mike Defensor declared that members of the executive committee and of the board will face separate charges.

For IT and similar issues, the joint panel recommended charges against the same officials as well against former PhilHealth chief Roy Ferrer and IT chief Jovita Aragona.

All-case rate system

The joint committee likewise flagged PhilHealth over the issue in its all-case rate system, which Defensor earlier claimed has resulted in billions of pesos of losses from the state insurer's funds.

A 2013 PhilHealth circular said the case-based payment is a payment method that reimburses to healthcare providers a fixed rate for each specific illness or case, but Defensor said this system has led to PhilHealth paying hospitals the fixed rate even if the cost incurred by a PhilHealth member is much less.

Citing the Commission on Audit, the panel report said PhilHealth had already overpaid hospitals around P102.5 billion between 2013 and 2018, while estimated losses due to fraudulent activities amounted to P51.2 billion.

All in all, the total estimated loss from 2013 to 2018 is about P153.7 billion, it added.

Moreover, the panel report said that the 22% overpayment and 78% underpayment record of PhilHealth's case rate system "ultimately benefitted private hospitals."

"In summary, while PhilHealth claims it is struggling financially due to the ongoing COVID-19 pandemic and asserts that its remaining actuarial life is down to one year, the Joint Committees find, based on the data provided in the several submissions by PhilHealth, that PhilHealth has been overspending on COVID-19," it added.

The two committees also recommended the filing of charges for alleged violation of the PhilHealth Charter and the Anti-Graft and Corrupt Practices Act against former Health secretary Enrique Ona, chairperson of the PhilHealth Board in 2013, and all ex-officio and appointed board members which approved the policies governing the all-case rate system.

Disadvantageous settlement of cases

The joint panel has also recommended charges against several officials over what they described as PhilHealth's "disadvantageous settlement of cases" involving hospitals, healthcare institutions, and other entities in previous years.

These included the cases of:

  •     Perpetual Succor Hospital of Cebu Inc.
  •     Cardinal Santos Medical Center/Hospital Managers Inc.
  •     Medina General Hospital
  •     Accenture Inc.
  •     WellMed Dialysis and Laboratory Center
  •     B. Braun Avitum Philippines, Inc. and Balanga Rural Bank Inc.

President Rodrigo Duterte earlier ordered the filing of charges against Morales and other officials linked by an inter-agency task force to irregularities in the IRM, procurement of ICT equipment, and policy for accountability.

Resigned PhilHealth anti-fraud officer Thorsson Montes Keith has 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.

In a phone interview with GMA News Online, Duque maintained that the allegations had “no basis” and that he was not part of the deliberations.

“‘Yung sinasabi ko, I was not part of it. 'Di ba lagi ko sinasabi ‘yan? Wala akong pirma, the resolution will show I have no signature, I was absent. Then number two… the Universal Health Care Law, Congress removes the voting power or the voting right of the Chairman of the Board,” Duque said.?

“So I was absent for almost four months, so wala. I was not part of the deliberations, the discussions, and the approval. So wala talaga,” he added.

The secretary also denied involvement in the irregularities involving the IT system.

“’Yung mga procurement sa IT, that’s very operational. Management ‘yan eh. Hindi naman ‘yan trabaho ng Board para bumili ng equipment. That is not the job of the Board, the Board is setting policy direction,” Duque said.

“Doon naman sa IT budget, that budget was still being deliberated when there was no approved budget for the IT because it was still being deliberated. So wala pa. No contract, no nothing. No contract was ever entered into by the PhilHealth management,” he added.

The Health secretary also earlier told a House panel hearing that he had no say in the IRM, even as the Senate Committee of the Whole recommended charges against him, among other PhilHealth officials, over the "improper and illegal implementation" of the said system.

In a taped public address aired Tuesday morning, President Rodrigo Duterte defended Duque anew from corruption allegations.

“Mind you, Secretary Duque was not a part of PhilHealth. As a matter of fact, he was not even reporting. That’s why ‘yung Kongreso sabi niya i-suspend or oust si Duque, I said, for what?” he said.

"What ground would I base my decision? Would I just obey the cry of 1 million as against my assessment na si Duque walang nanakaw kung pera ang pag-uusapan?” he added.

Duterte also said that he will not abolish PhilHealth, contrary to his previous plan.

“‘Yung PhilHealth wala na, skeletal ang na-remain diha. Talagang hindi ko bubuwagin ‘yan because hindi madali, it’s not easy really to create another one,” Duterte said in a taped address aired on Tuesday.

“I think by this time marami na kasing na-suspend.”

Duterte said last month that he would ask Congress to pass a law to abolish PhilHealth amid the alleged anomalies hounding the state-run health insurer.—Joahna Lei Casilao/AOL, GMA News
 

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