COA questions P14.97 billion in PhilHealth emergency payments

The Commission on Audit is questioning payments made by the Philippine Health Insurance Corporation (PhilHealth) amounting to P14.97 billion under its interim reimbursement mechanism.

In its report, COA said PhilHealth released the funds to various healthcare institutions nationwide under the IRM scheme for services not yet rendered, which was contrary to Presidential Decree No. 1445 that prohibits advance payments for services, supplies, and materials not yet delivered under government contracts except with the prior approval of the president.

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.

According to COA, PhilHealth did not establish "definite guidelines and criteria or organize an evaluation team" for the healthcare institutions applying for the IRM grant, contrary to the provisions of PhilHealth Circular No. 2020-0007.

"As a result, HCIs that are not directly involved in facilitating/providing COVID-19 related health care services and those with alleged violations with PhilHealth policies were granted IRM funds totaling P783.734 million and P3.115 billion, respectively," COA said.

The COA also questioned the release of P7.64 billion in IRM funds to 503 HCIs without deducting the 2% creditable income tax required by the Bureau of Internal Revenue Regulation.

Moreover, state auditors said PhilHealth also granted IRM funds amounting to P10.65 billion to 488 HCIs, but the amounts released were more than what was allowed under PhilHealth Circular No. 2929-0007 and its corresponding PhilHealth Standard Operating Procedure Nos. 2020-02-02-007 and 2020-02-02-008, resulting in excessive releases by a total of P81.507 million to P2.208 billion.

GMA News already reached out to PhilHealth regarding the matter but it has yet to respond as of posting time.

Lacson fact-checking

Over the weekend, Senator and presidential aspirant Panfilo “Ping” Lacson said his team has been in coordination with the Justice Department regarding the payments.

In a statement released Sunday, Lacson said he is having the P15-billion advanced payments by PhilHealth fact-checked.

“I’m having it fact-checked now… If my memory serves me right, this is actually what we uncovered and exposed during our [Commission on Audit] hearings on the [interim reimbursement mechanism (IRM)] and other misuses of PhilHealth funds,” he was quoted as saying in a report on GMA’s “24 Oras Weekend.”

Resigned PhilHealth anti-fraud officer Thorsson Montes Keith claimed that the agency’s “mafia” stole such an amount through fraudulent schemes.

“We turned over voluminous documents to the [Department of Justice] for the filing of criminal and administrative complaints against former and incumbent officials of PhilHealth,” Lacson added.

The agency has maintained that the controversial P15 billion in advanced payments through its IRM was not missing, as it had liquidated 98% of the amount.

PhilHealth has since suspended its IRM system "to review its overall implementation and resolve issues arising from congressional inquiries."

Congressional investigations last year 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.

GMA News has sought comment from Philhealth on the matter but officials have yet to respond as of posting time. —  with Jon Viktor D. Cabuenas/DVM/BM, GMA News