PhilHealth HFPS office urged IRM funding for dialysis centers –SVP

Cavite Representative Elpidio Barzaga Jr. on Monday questioned the Philippine Health Insurance Corp. (PhilHealth) over the inclusion of dialysis centers among healthcare institutions receiving funds through the internal reimbursement mechanism (IRM) even as the dialysis treatments were not "fortuitous" events like COVID-19.

"Bakit natin sinama ang mga dialysis center na alam naman ng bawat isa, hindi sila nagdi-dialysis sa mga COVID patients?" Barzaga asked PhilHealth Senior Vice President Dr. Israel Pargas.

"Kapag sinabi mong state of calamity, ang state of calamity natin ay COVID. Yung dialysis center, it has been there for so many years," the representative added.

Pargas explained that the intent of the IRM was not necessarily only for COVID-19 cases "but really because of the effect of the pandemic."

"That's why kasama yung mga dialysis and even the maternities," the PhilHealth senior vice president added.

Nevertheless, Pargas agreed with Barzaga that dialysis was not considered a "fortuitous" event.

House Committee on Public Accounts chair Mike Defensor earlier presented a list of healthcare institutions, which included several dialysis centers, that received IRM funds despite having a record of fraudulent cases.

As to which PhilHealth executive committee members proposed to including dialysis centers among those who would receive IRM funds, PhilHealth Senior Vice President Atty. Rodolfo Del Rosario said that he did not know, though the minutes of the executive committee's meetings would have recorded the matter.

For his part, PhilHealth Senior Vice President Renato Limsiaco Jr. said that the proposal came from Pargas' office.

When Barzaga asked Pargas to admit that the proposal came from him, the latter finally said that the PhilHealth's Health Finance Policy Sector, which he heads, was the one that proposed that all accredited facilities, including dialysis centers, could receive IRM funds.

"Sir, we did. The HFPS proposed for all the accredited, I was part of the execomm," Pargas told Barzaga.

PhilHealth last Thursday announced that it had 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 added.

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. — DVM, GMA News