Recto : PhilHealth must probe deeper, act on claims of gov't hospitals faster

Senate President Pro Tempore Ralph Recto today urged PhilHealth to probe deeper into the fraudulent payments it made to private clinics and hospitals to find out if recipients of multi-million-peso reimbursements had help from the inside.

This as Recto called for heavier penalties on those who pad or invent insurance claims, whether they are health professionals, institutions, state workers or employees of PhilHealth themselves.

In today's Blue Ribbon Committee hearing on the alleged scam involving excessive payments on ghost or questionable treatments, Recto prodded PhilHealth officials to conduct an internal investigation.

PhilHealth President Alexander Padilla said the investigation they had done so far showed no collusion from within the agency.

"We followed the money and all the money went to private health care institutions," Philhealth CEO and President Alex Padilla said.

To dispel all doubts, Recto said the Commission on Audit (COA) must review some of the claims.

Upon questioning by Recto, the PhilHealth CEO said that most of the erring parties were private health care providers.

Recto said PhilHealth should likewise divulge government hospitals which tried to pull a fast one on the state health insurer.

Recto noted that two-thirds of PhilHealth reimbursements went to the private sector "and it seems that claims applied for by them were acted somewhat expeditiously by PhilHealth."

"Bakit kung private eye centers ang bilis ng processing pero kung government hospitals medyo mabagal?" said Recto, citing applications by public hospitals in Batangas whose approval "could have been done in a faster manner."

"Hindi ba tell-tale sign ito na meron talagang expediters sa loob ng PhilHealth?" Recto said.

Recto said he also noted that payouts involving indigents, at P25 billion last year, was smaller than the P37 billion that government shelled out in premium cost for indigents it enrolled in PhilHealth during the same year.

On this, he urged Padilla to step up its information campaign "so those who are covered but don't know they are would be informed that they have medical insurance."

He cited the case of the recent law granting automatic coverage to citizens 60 years old and above "a good news which has yet to attain a 100 percent awareness level on its supposed beneficiaries."

To deter scams, Recto said stiffer fines must be imposed "because what's being stolen here is taxpayer's money and what is stolen from pool reduces the resources which can be given to deserving claimants."

"Sa ngayon kasi batay sa IRR ng RA 10606 or The PhilHealth Act of 2013, ang fine ng isang doctor na nameke ay P50,000 to 100,000 na kayang-kayang bayaran, o kapag ospital naman ay P50,000 to 100,000 plus suspension or revocation ng Philhealth accreditation lang," he said.