The syndicate of crooks inside state health insurer Philippine Health Insurance Corporation (PhilHealth) has too much control of the agency’s operations that it can impose its will in diverting funds to go straight to the pockets of its members.

Former PhilHealth president and chief executive officer Eduardo Banzon told the House joint panel probing PhilHealth anomalies yesterday said that even the agency’s information technology (IT) system was manipulated to allow the syndicate or the mafia to pilfer funds.

Banzon said this was discovered during his term and he immediately ordered an internal investigation. Access to the database was disabled and later limited to top officials, Banzon said.

Nonetheless, National Bureau of Investigation-Anti Fraud Division (NBI-AFD) head Minerva Retanal said in her testimony that the fraud continued and the intrusion of the data system in the agency even came from “an insider.”

“One employee had a remote access to the system to intercept financial transactions. That person can alter the data to make it appear that these payments were received by PhilHealth,” she explained.

Retanal said one of the cases of diversion on contributions involved those with business process outsourcing firm Accenture.

The NBI did not complete its investigations into that particular case since PhilHealth was able to settle amicably with Accenture.

She also cited an instance in which investigators found an employee in charge of delivering the checks of Accenture accounts as having been paid off.

“What happened was that the checks were intercepted from the messenger (of Accenture) and he was given, because it was done by a syndicate, a fake receipt for the diverted contributions,” she explained. The NBI-AFD head said the persons who withdrew the money were identified and are subjects of investigation.

The House panel also adopted a motion disallowing the use of the Interim Reimbursement Mechanism (IRM) for cases other than coronavirus disease (COVID).

Marikina Rep. Stella Quimbo presented during the hearing liquidation reports submitted by PhilHealth which showed that some IRM funds disbursed by PhilHealth were not used for COVID-19 cases.

“The IRM was designed by PhilHealth as a COVID response. The liquidation reports from PhilHealth, however, indicated that of 458 hospitals that liquidated the IRM, 346 did not have even a single COVID patient. Zero COVID claims totaled P1.2 billion,” Quimbo said.

Senior vice presidents Renato Limsiaco Jr. and Israel Pargas clarified before the joint panel that IRM is not only intended for COVID 19 cases but for other illnesses.

Probable, suspected
Quimbo, however, criticized PhilHealth Circular 2020-007 on the IRM which allowed PhilHealth to cover costs of probable and suspected COVID-19.

Quimbo said the use of IRM funds for other illnesses is alarming as this might lead to the displacement of COVID-19 patients.

“The misuse of the IRM funds in allowing it to be used for non-COVID cases will lead to the displacement of COVID patients requiring hospitalization, and possibly contributing to the spread of the virus,” she explained.

“By the time COVID patients go to these hospitals, the IRM had already been used up for other illnesses that does not have any connection to the pandemic,” Quimbo said.

Quimbo appealed to the PhilHealth to suspend application of IRM altogether and introduce a simple expedited claims processing dedicated to COVID.

PhilHealth had suspended the release of IRM funds which are payment to hospitals in case of fortuitous events such as COVID-19 pandemic, pending review on the reimbursement program, after allegations that PhilHealth favored private owned hospitals over public hospitals in the distribution of IRM funds.

PhilHealth has so far released P14.9 billion of the P30 billion IRM funds to over 700 health care institutions nationwide.

Effort not wanting
Malacañang also denied alleged shortcomings in the government’s pandemic response, following Vice President Leni Robredo’s criticism that there seems to be no one in charge of the health crisis.

Presidential spokesperson Harry Roque said he “strongly disagrees” with Robredo’s claim, arguing that the Philippines would have seen more deaths due to COVID-19 if there was no strategy.

“It’s not true that our response is lacking. Maybe it’s easy to criticize if one is not in the middle of the fight and not the one expected to act,” Roque told reporters in a Palace briefing.

The Palace official also urged Robredo to refrain from politicking. “The President is not criticizing VP Leni. He has recognized and he has been recognizing the contributions of VP Leni,” Roque said.

“The President’s call is to unite amid this pandemic. Set aside politics. It’s still far from now. Many things will still happen until 2022,” he added.

Department of Health Secretary Francisco Duque III said he welcomes his inclusion in the proposed Senate inquiry on the PhilHealth scandal as a way to clear his name over allegations of corruption.

“My public service record is an open book. If there is a single thread of conclusive evidence of my involvement on any and all issues, then let the axe fall,” he said.

In his statement, he said that being accused as ‘godfather’ of the mafia behind the alleged corruption in the PhilHealth has affected both him and his family.

He claimed that accountability and transparency have been his ‘guidepost’ in serving as a government official even back in 2001 when he was first tasked to be the PhilHealth president under the administration of former President Gloria Macapagal-Arroyo. (Daily Tribune)