BY RAYMOND AFRICA and WENDELL VIGILIA
A FORMER official of the Philippine Health Insurance Corp. (PhilHealth) yesterday tagged Health Secretary Francisco Duque III as godfather” of a mafia that is allegedly operating at the state insurer, while another official who is now on floating status said Duque is aware of all the problems in the agency but has done nothing to address these.
Duque denied the allegations. “I would like to state for the record that I am for zero tolerance on fraud and corruption,” he said adding that in his early years with PhilHealth in 2001, he asked the National Bureau of Investigation investigate reports of fraud in the corporation.
Duque, Thorrson Montes Keith, who recently resigned as PhilHealth anti-fraud legal officer, and Dennis Adre, PhilHealth regional vice president who has been on floating status since September last year, made the statements during the third hearing of the Senate committee of the whole on alleged corruption in the state agency.
At the House, the committee on public accounts and on good government, which are jointly conducting similar hearings, summoned representatives of 45 hospitals that have pending fraud cases with PhilHealth from 2013 to 2018.
Lawmakers believe anomalies in the agency are being committed by PhilHealth officials in cahoots with hospital personnel.
Rep. Michael Defensor, chairman of the public accounts panel, said the representatives of the hospitals will be made to physically appear before lawmakers or through online platforms on Thursday, noting that many of these hospitals have 10 fraud cases each while only one has two cases.
At the Senate hearing, Keith said Duque, who is PhilHealth board chairman, knows about the irregularities in the agency, including on the implementation of the interim reimbursement mechanism (IRM), but did nothing to at least correct the anomalies.
“Maituturing ko po na siya ang godfather ng mafia sa dahilan na marami siyang mga (inaprubahan) doon po sa IRM … meron dapat due diligence na gagawin ang isang chairman, and considering he is a doctor and he has institutional knowledge sa pamamalakad sa PhilHealth (I consider him the godfather of the mafia because he approved a lot in relation to the IRM… he should have done due diligence, and considering he is a doctor and he has institutional knowledge in running PhilHealth…” he said.
Earlier, Sen. Panfilo Lacson said the existence of the PhilHealth “mafia” was felt when PhilHealth president and chief executive officer Ricardo Morales was swayed by members of the PhilHealth executive committee (execom) to force Augustus de Villa to resign as vice president for operations due to loss of confidence.
The PhilHealth execom is composed of the corporations’ senior vice presidents.
Keith said Duque should not have not been silent when reports on PhilHealth anomalies were disclosed.
He said Duque can be equally liable for the irregularities in PhilHealth as the health secretary is the chairman of the board.
“Meron siyang command responsibility at halos lahat ng members ng mafia ay halos siya ang nag approve ng appointment, mga members ng mafia sa PhilHealth (He has command responsibility and the appointments of almost all the members of the mafia were approved by him),” Keith added.
HARASSMENT CASES
Adre said Duque gave his “blessings” to file administrative charges against any PhilHealth officer who will oppose the corporation’s “flawed” policies.
“All these harassment and oppression cases against officers who advocated reform had the blessing of the chairman of the board of PH,” he said.
Duque denied this.
Adre said Duque connived with the members of the PhilHealth execom to silence officials who openly question irregularities.
“The DOH secretary knows all that is happening in PhilHealth. He has been in PhilHealth for 20 years after all. In 2004, he launched a major financial loss caused by the ‘Plan 5 million.’
It was the first time financial statements were window-dressed in 2004 after PhilHealth lost millions in unpaid claims for the indigents for the Plan 5 million,” Adre said.
Adre said “Plan 5 million” was the project of former President Gloria Arroyo, who was then running as president, to give away five million PhilHealth cards to the public in apparent bid to offset the five-million lead garnered by the late Fernando Poe Jr. in a poll survey held before the 2004 elections.
He said those who questioned “Plan 5 million” were “punished” by transferring them to other posts. He said he was one of those affected by the opposition to Plan 5 as he was transferred from the Davao regional office to the Central Mindanao regional office.
He said a similar advance payment schemes to health care institutions, just like the IRM, were introduced by PhilHealth officials way back 2010. He said that time, Duque was chairman of the Civil Service Commission, who also became PhilHealth board member after an executive order was issued by Malacañang making the CSC part of PhilHealth.
He also said the “all case rate” system for all illnesses was introduced in 2010, which he and the other regional vice presidents opposed, just like they opposed the advance payment system, as those programs, they said, will be open to corruption.
“Many regional vice presidents resisted the advance payment plan because it was illegal. It was very much like the IRM today, where PhilHealth is required to pay hospitals in advance without the benefit of claims evaluation,” he added.
Adre also disclosed that PhilHealth paid P9.5 million for an anti-fraud system that he and a number of employees from PhilHealth Davao region developed. He said the payment was illegal because the developers are PhilHealth employees ho used the agency’s resources in the developing the system.
“We are the good mafia. They are the real bad mafia,” Adre added.
HOSPITALS
At the House, Cavite Rep. Elpidio Barzaga, president of National Unity Party, said the joint panel should also find out if hospitals have also received funds from the fraudulent IRM scheme.
The 45 hospitals that Defensor wants summoned are different from 51 others that are facing cases of fraud after receiving IRM funds worth P1.4 billion.
Barzaga also earlier questioned PhilHealth’s policy that included dialysis procedures in the P27 billion that the agency allocated for the coronavirus disease 2019 (COVID-19) patients.
Of the 45, the Tamparan Medical Foundation in Lanao del Sur has the most number of fraud cases, with 431, followed by Butuan Doctors Hospital with 226 and Baguio General Hospital with 129.
Domingo Casano Hospital in Dolores, Eastern Samar has the fewest record cases of fraud with only two.
“We want to know the nature of the cases and understand how fraud is committed in PhilHealth,” Defensor said.
The rest of the 45 hospitals are Abra Provincial Hospital, Benguet General Hospital, Bishop Regan, Cagayan de Oro Maternity Children’s Hospital, Bontoc General Hospital, Conner District Hospital, Cuison-Zabala Birthing Home, Divine World Hospital, Domingo Casano Hospital, Dr. Pablo Torre Sr. Memorial Hospital, Eastern Sun Medical and Diagnostic Center, Fabiola Gabriel Center, Holy Trinity Medical Clinic, Kalinga District Hospital, Leona Lim Memorial Hospital, Lepanto Consolidated Mining Company Hospital, and Luis Hora Memorial Hospital.
The rest are Lutheran Medical Mission and Rehabilitation Foundation, Mercy Community Hospital, Michael Abutazil Hospital, Misamis University Medical Center, Moorehose Mission Hospital, Notre Dame de Charles Hospital Oras Doctors Hospital, Ozamiz City St. Joseph General Hospital, Pacific Eye Institute, Panopdopan District Hospital, Pathfinder Estate Hospital, Paul Jesus Midwife Clinic, Pines City Doctor’s Hospital, Potia District Hospital, Quezon City Eye Center, SAA Healthcare, St. Louis University of the Sacred Heart, San Pedro Hospital of Davao Inc., St. Theresa Wellness Center, St. Therese Hospital, St. Theodore’s Hospital, St. Mary’s Hospital Maternity and Children’s Hospital (Iligan City), United Doctors Hospital of Kidapawan, Inc., University of Perpetual Help, Dalta Medical Center, Inc. and Dr. Petronilo V. Seares Memorial Hospital.
MALVERSATION
Lacson said that PhilHealth president Ricardo Morales and senior vice president Renato Limsiaco may be held liable for malversation for not withholding taxes from cash advances made through the IRM.
Lacson said Limsiaco “patently lied” before the Senate committee of the whole last week when he said he was unaware that taxes needed to be withheld in such instances.
Based on a memorandum issued by Morales, PhilHealth has remitted 2 percent expanded withholding tax at the BIR regional district office in Pasig City last August 3, which came from the total amount of P156,738,887 released from the IRM to health care institutions up to July 31.
Also in the memo, Morales instructed all regional vice presidents to issue BIR form 2307 or the “Certificate of Creditable Tax Withheld At Source” to health care institutions (HCIs) even if the actual withholding taxes were not yet paid by the respective HCIs.
During last week’s hearing, Limsiaco said PhilHealth was not yet able to withhold taxes from IRM releases and instead paid P156 million in advance to the BIR, which represents the withholding taxes to be collected from HCIs. He said the P156 million came from PhilHealth’s capital outlay.
Lacson said PhilHealth officials may also be accountable for violation of the National Internal Revenue Code and Anti-Graft and Corrupt Practices Act in connection with the IRM anomalies.
He said Justice Secretary Menardo Guevarra will be furnished copies of evidence that the Task Force PhilHealth can use in filing charges against erring PhilHealth officials.
