IT WAS only last year that the fraudulent claims of WellMed Dialysis & Laboratory Center Corp. came to a head with the National Bureau of Investigation filing complaints of estafa and falsification of public documents against the said company on June 11, 2019. Apparently, WellMed had been filing medical claims to the PhilHealth on behalf of deceased patients, or patients who had not been getting their full weekly treatments.
Sen. Ping Lacson, in a privilege speech delivered on July last year, claimed that WellMed Dialysis Center received around P4.24 million in reimbursements from PhilHealth, from January to June 2019. Unfortunately, the cases filed were dismissed on Aug. 5 for lack of jurisdiction. This, and other cases that involved PhilHhealth, led to a Senate Blue Ribbon investigation shortly thereafter.
This past week, the Senate started yet another investigation into PhilHealth irregularities, this time as the Committee of the Whole (COW) True enough, the hearing uncovered, among many other serious issues, that more than P15 billion had allegedly been wasted or stolen over the years due to many questionable transactions. Worse, PhilHealth is already using its reserves, and is expected to have a net loss of P90 billion this year, and P147 billion next year, as benefit payouts increase due to the COVID-19 pandemic. Actuarial analysis by PhilHealth even projected that reserves would run out by 2021.
Clearly, urgent action must be taken — comprehensive reforms must be made. To that end, I proposed the following during my turn at the COW investigation.
The first is for a special audit of PhilHealth’s finances to be conducted, similar to what was done concerning the Priority Development Assistance Fund when the serious issue with Janet Lim-Napoles came to light. Next, the Governance Commission for GOCCs (GCG) should be invited to the hearings to guarantee the validity and legitimacy of the special audit, as well as report on PhilHealth’s performance score. The Commission on Audit (COA) should also be invited to succeeding hearings to see if PhilHealth is complying with the observations and recommendations of the commission expressed in recent annual audit reports. The Senate should also issue subpoenas for PhilHealth’s data concerning medical claims and financial information.
Since one of the major issues with PhilHealth this time around concerns their recent procurement of information technology (IT) equipment and software, they should also present their Information Systems Strategic Plan (ISSP), and explain how their purchases are justified, both in terms of price and use. Their ISSP should also be validated by the proper government departments – in this case, the Department of Information and Communications Technology. Officials from the Department of Budget and Management should also be invited to the hearings, particularly those from the Procurement Service and the Philippine Government Electronic Procurement Services, or PhilGEPS, to check and see if overpricing happened in the procurement of the IT system components. Agencies that have successfully transitioned to digital systems, as well as private sector experts, may also be invited for their inputs.
When it comes to the PhilHealth Board members themselves, the Senate’s investigation should delve deeper to see if the current policy framework ensures that those appointed to the board are independent, qualified and committed to safeguarding PhilHealth’s funds. The Office of the Ombudsman should also consider investigating high-ranking PhilHealth officers, with preventive suspensions implemented when necessary. The Presidential Anti-Corruption Commission (PACC) should also be invited to present the findings of their investigation.
These are just initial recommendations, as the Senate’s investigation is still ongoing. But some courses of action could already be taken. PhilHealth President and CEO Ricardo Morales said during the Senate inquiry that 20,000 cases of possible fraud are being investigated now, and that additional investigators were hired to handle the heavy caseload. There is nothing stopping the justice system from charging, convicting and imprisoning the guilty — which in turn could serve as a deterrent to any further corruption.
My late father, Senate President Edgardo J. Angara authored the National Health Insurance Act of 1995 (RA 7875) which established PhilHealth. His vision was for PhilHealth to play a decisive role in ensuring that our people remain healthy. I can’t help but be saddened that it is now suffering from inefficiency and has allegedly become the venue for unconscionable levels of corruption. Nothing less than sweeping and decisive changes must be made so that PhilHealth remains a trusted pillar of our healthcare system.
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Sen. Sonny Angara has been in public service for 15 years — nine years as Representative of the Lone District of Aurora, and six as Senator. He has authored and sponsored more than 200 laws. He is currently serving his second term in the Senate. (Email: sensonnyangara@yahoo.com | Facebook, Twitter & Instagram: @sonnyangara)/PN
