House panels to summon hospital execs to PhilHealth mess probe

Defensor said these hospitals have outstanding fraud cases from 2013 to 2018. (File photo: Michael Tan Defensor/Facebook)

MANILA – Two panels at the House of Representatives have summoned officials from several hospitals with pending cases of fraud to attend a congressional hearing on the alleged corruption in the Philippine Health Insurance Corp. (PhilHealth).

During the joint hearing of the House Committee on Public Accounts and Committee on Good Government and Public Accountability, Anakalusugan Party-list Rep. Michael Defensor invited the officials of around 45 hospitals involved in fraudulent schemes and transactions with the state health insurer to testify before the panels.

Defensor said these hospitals have outstanding fraud cases from 2013 to 2018.

“We want to know the nature of the cases and understand how fraud is committed in PhilHealth,” Defensor told reporters. “Yung fraud, to my mind, is committed with the hospitals. We have to understand how it’s being done. For example, sa pneumonia dapat may x-ray. Paano kung may usapan and hindi na i-require? (the case of pneumonia requires chest x-rays [for accurate diagnosis]. What if there is already a deal [between PhilHealth and the hospitals] not to require it?).”

Based on the list of hospitals, those with the highest fraud-related cases include the Baguio General Hospital, Butuan Doctors Hospital and College, Fabiola Gabriel Center, Notre Dame de Charles Hospital, Tamparan Medical Foundation, Leona Lim Memorial Hospital, and Benguet General Hospital, among others.

Defensor, however, noted that not all of these hospitals are part of the 51 healthcare institutions that have received Interim Reimbursement Mechanism (IRM) funds amounting to almost PHP1.5 billion from the PhilHealth despite pending fraudulent cases against them.

In the previous hearing, Defensor cited PhilHealth records showing that 4,664 fraudulent cases have been reported from 2013 to 2020.

These offenses include padding of claims, post-dating of claims, extending the period of confinement, misrepresentation by furnishing false or incorrect information, unjustified admission beyond accredited bed capacity, unauthorized operations beyond service capability and fabrication or possession of fabricated forms.

“With so many hospitals here in Metro Manila, in other provinces, we should not allow those that have fraud cases, those that have penalties, to continue to have such funds,” he said.

IRM is an advanced payment scheme that authorizes PhilHealth to give healthcare institutions cash in advance to respond to unanticipated events like natural disasters and calamities.