Clearly, the Philippine Health Insurance Corporation (PhilHealth) has a multitude of problems that has led to this situation where we have individuals and health care providers defrauding the government of hundreds of millions in funds that should be going to Filipinos struggling to cope with their medical needs.
This is not new as what we saw during the hearing. It appears there are unscrupulous individuals within the PhilHealth who have access to the database of members and are manipulating the processing of claims for their own benefit.
What is very clear is that these PhilHealth evaluators have very broad discretionary powers that allow them to increase, deflate and accelerate the processing of claims.
While we are still uncovering more anomalies taking place within our state health insurance provider, there are already steps that we can take to help stop the bleeding.
First, Philhealth should beef up its anti-fraud system. Mas maraming “integrity units” to vet, validate and verify claims, hindi naman lahat but at random, to capture inaccuracies.
Meron dapat na tulad ng internal affairs service sa kapulisan na nakatutok sa mga procedures. At ngayon na si Gen. Ricardo Morales ang president at CEO ng PhilHealth, tiyak na kayang kaya niya ipatupad ito.
Don’t get me wrong, we’re not talking about instituting a spy system within PhilHealth, but rather a system that will be able to spot anomalies efficiently.
Anti-fraud is a necessary expense that is self-recouping because it deters costly fraud that would leave a hole in PhilHealth’s pocket.
For a multi-billion corporation, PhilHealth should have in place a strong IT system that is capable of coming up with a more transparent billing process. If the telcos are capable of counting, up to the last second, the calls and texts of tens of millions of its subscribers, then why can’t PhilHealth do something similar so that its members would be able to know how much they will have to pay for their hospitalization.
It should be noted that both the PhilHealth charter and the Universal Healthcare Act contain penal provisions against illegal acts. Has the PhilHealth been able to go after anyone from within its ranks who were involved in these scams? I find it disturbing that we do not seem to hear about any PhilHealth personnel being charged either administratively or criminally. Ang mas maugong ay ang parami ng parami na mga kaso ng fraud na nangyayari sa PhilHealth na mukhang walang ginagawa para mapigilan ito.
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