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Go demands truth, solutions from PhilHealth executives

August 15, 2019 - Thursday 4:08 PM by MDM

Article Banner Image Senate Health Committee chair Senator Christopher Lawrence Go confers with Blue Ribbon Committee chair Senator Richard Gordon at the start of the probe on allegations of anomalies at PhilHealth on Wednesday.

Senator Christopher Lawrence Go on Wednesday said the the people “deserve to know the truth” behind the alleged anomalies involving the Philippine Health Insurance Corporation (PhilHealth).

“Kailangang malaman ng Senado at ng taumbayan ang katotohanan sa isyung ito. Interes ng bawat Pilipino ang dapat manguna,” Go said in his opening statement during the Senate inquiry on the allegations of anomalies in PhilHealth.

The Senate Committee on Health, which Go chairs, and the Senate Blue Ribbon Committee headed by Senator Richard Gordon are conducting a joint investigation on the alleged fraudulent claims that PhilHealth granted to certain health care facilities and providers, including WellMed Dialysis and Laboratory Center (WellMed).

WellMed, based in Quezon City, allegedly filed falsified benefit claims with PhilHealth on behalf of deceased patients, receiving at least P800,000 using this scheme.

Go questioned past and present PhilHealth officials on how the claims were able to pass through several stages of review.

“May submission of claims and then adjudication by benefits. May administration sector, so dadaan at i-tse-check ninyo, then medical review by doctors, i-tse-check ninyo, and then payment approval. Puro po ito sa PhilHealth, so bakit po nakakalusot itong mga up-casing, itong mga overpayment, itong fraudulent claims?” he said.

Gilda Diaz, PhilHealth’s vice president for the National Capital Region, admitted that the claims system of the state-run corporation failed to detect the anomalies.

“Yung sinasabi po nilang ghost claims po, hindi ho talaga siya na-detect sa claims system namin,” she said.

Diaz said her office only learned of the case when the investigation was done and PhilHealth had to withdraw WellMed’s accreditation.

Go asked the same question to Dr. Roy Ferrer, who served as PhilHealth acting president and CEO from June 2018 to June 2019. 

Ferrer answered that one of the reasons is the lack of health care professionals to check the claims.

But Ferrer also admitted that corruption exists within the ranks of PhilHealth. “We cannot deny that some of our employees are in cahoots (with private hospitals),” he said.

Apparently incensed at the answer, Go challenged newly appointed PhilHealth president Ricardo Morales to address the problem.