Serial Corruption Plagues Philippines National Health Insurance

Serial Corruption Plagues Philippines National Health Insurance
Photo Credit: AP / TPG Images
What you need to know

Philippine Health Insurance Corporation (PhilHealth), a state healthcare insurer affiliated with the Department of Health, is embroiled in a Senate probe involving thousands of fraudulent claims and mismanagement of funds.

MANILA, Philippines - Hospital beds are filled with Covid-19 patients as the Philippine government desperately tries to put a stop to the virus outbreak. But as medical workers scramble to save lives, a state-owned health insurance provider has allegedly engaged in systematic corruption.

Philippine Health Insurance Corporation (PhilHealth), a state healthcare insurer affiliated with the Department of Health, is embroiled in a Senate probe involving thousands of fraudulent claims and mismanagement of funds.

In the senate hearing, PhilHealth’s anti-fraud officer Thorrsson Montes Keith said that he resigned out of “disgust” and alleged mafia connections within the agency. Keith also called Health Secretary Dr. Francisco Duque III “the godfather of the mafia” because he approved the appointments of the alleged mafia members in PhilHealth.

The investigation came after PhilHealth officials were accused of pocketing US$310 million through a program called Interim Reimbursement Mechanism (IRM). IRM can bypass usual procedures, allowing its regional offices to speed up the reimbursement process for insurance claims to healthcare facilities during “fortuitous circumstances.”

Officials were also accused of misusing funds on a US$43 million IT project, which included a laptop that cost a whopping US$2 million.

RTX7O4KH
Photo Credit:Reuters / TPG Images
Health workers ask questions to residents before getting free coronavirus disease (Covid-19) swab testing at a gymnasium in Navotas City, Metro Manila, Philippines, August 7, 2020.

Both Secretary Duque and PhilHealth legal counsel Roberto Labe Jr. refuted these claims. Labe said there are IRM receipts that can prove the disbursement of funds to healthcare facilities “assure [an] efficient response to the Covid-19 pandemic.”

This is only one of the many corruption scandals PhilHealth has found itself in over the past years. The latest investigation has provoked panic and anger among the PhilHealth contributors who are living hand to mouth to keep their health insurance coverage during a devastating pandemic.

“The PhilHealth anomaly is a ticking bomb waiting to go off, and it did,” Roxanne Araniador, a PhilHealth member, told The News Lens. “We pay to get covered only to find out that the money is gone. It’s frustrating when we all work hard and those top officials were just there living like kings and queens.”

But PhilHealth is not alone in committing fraud. Public and private hospitals, medical professionals, and government officials in the Philippines have been involved in similar schemes. A hospital was caught admitting its janitors as PhilHealth-accredited patients. An eye doctor also claimed US$330,000 for having performed 2,071 operations in one year.

AP_20232333815551
Photo Credit: AP / TPG Images
People wear face mask and face shields to help curb the spread of Covid-19 as they walk along the streets in Quezon city, Philippines on Wednesday, Aug. 19, 2020.

Anne, a former PhilHealth employee who requested a pseudonym for fear of reprisal, said that she noticed some fraudulent claims during her time at the company.

“A patient who died of diabetes was declared Covid-positive by the hospital and she wasn’t even swabbed,” Anne told The News Lens. “A Covid-19 patient gets compensated for up to US$16,000, which is shared with the hospital, the doctor, and the patient itself.”

Some workers in the hospital also told her that they would declare different diagnoses to claim bigger benefits.

Even an interim PhilHealth president took advantage of the corrupt system. In 2018, Celestina Ma. Jude Dela Serna was found to have spent over US$19,000 on personal expenses in just one year while the state company suffered a massive loss of revenue. Instead of renting a house in Manila, she opted to stay in a hotel that cost US$78 a night while she was in office.

President Duterte immediately fired Dela Serna after the news broke about her extravagant lifestyle. But she was not the last to abuse a system meant to provide adequate health services for the people.

Since 2013, PhilHealth has lost US$3.1 billion over bogus claims involving the state health insurer’s top officials.

READ NEXT: How Is the Philippines Plotting Its Tourism Recovery?

TNL Editor: Daphne K. Lee, Nicholas Haggerty (@thenewslensintl)

If you enjoyed this article and want to receive more story updates in your news feed, please be sure to follow our Facebook.