Undistributed insurance funds, ghost patients, and other fraudulent schemes were discovered during the resumption of the Senate’s continuing investigation into the Philippine Health Insurance Corporation’s (PhilHealth) alleged corruption scandal. 

Senate Majority Leader Juan Miguel Zubiri who chaired the Senate’s Committee of the Whole hearing, revealed the various anomalies in PhilHealth’s operations including the state health agency’s failure to distribute Interim Reimbursement Mechanism (IRM) funds to hospitals.

Hospitals who did not receive their IRM include the Ospital ng Maynila with P19.3 million, Western Visayas Medical Center’s (WVMC) with P121.4 million, and Corazon Locsin Montelibano Memorial Regional Hospital’s (CLMMRH) with P41.7 million. 

Zubiri noted that both the WVMC and CLMMRH are coronavirus disease 2019 (Covid-19) admission centers.

Ghost patients

PhilHealth’s ghost patient fraud scheme, where they fake records of non-existent patients to embezzle funding, was also raised during the senate hearing.

Zubiri alleged that the Golingay General Hospital received P18 million in 2014 and almost P10 million in the first semester of 2015, despite the hospital having an 18-bed capacity.

Cases of hospitals listing ghost patients under unused treatment supplies was also highlighted by the senator. He reported that there were instances where health centers would claim the dialysis sessions of patients that have passed away. 

Zubiri also noted instances of mild illnesses being reclassified as more severe ailments in order to gain larger sums of Hospital Confinement Indemnity (HCIs) Insurance. 

The legislator cited cases where hospitals upcase hypertension to a mild stroke, charging up to P25,000 in HCIs.

The senator rebuked PhilHealth Region I’s Senior Vice President (SVP) for Legal Rodolfo del Rosario for failing to act upon 220 cases of upcased HCIs which were filed since 2019.

“Kaya walang natatakot na mga erring HCIs, walang natatakot na hospital, dahil nga hindi naman sila kinakasuhan at hindi po sila pinaparusahan,” Zubiri said.

Pamela del Rosario case

Zubiri also revisited the case of Pamela del Rosario who was able to claim P1.7 million in cash assistance to help finance her and her family’s treatment for cancer. The National Bureau of Investigation (NBI) later found out that the del Rosario family was non-existent.

He revealed that cases against those involved in the Pamela del Rosario case were severely downgraded and eventually dismissed.

“Atty. Emily Roque filed only charges for simple misconduct against ten employees who had been positively identified by PhilHealth Anti Fraud Personnel. Last year, the cases against these employees were dismissed,” he said.

The senator added that PhilHealth’s  200-page report written on the case by the Fact-Finding Investigation and Enforcement Department was reduced to 20 pages by the Internal Audit Department, with the details of each employee’s involvement in the scam being removed.

The senate hearing also revealed that del Rosario’s fake cancer claims were processed by PhilHealth for an average of ten days as opposed to the standard 60-day process.

Lacking legal action

Zubiri largely attributes the rampancy of PhilHealth’s corruption to the lack of legal action being taken against their anomalous operations.

While these cases have been documented most of the fraud schemes have not been sanctioned, he noted.

“Problem number one, orders from the Legal Sector to ignore court rulings on fraud. Supreme Court and Court of Appeals (CA) Final Decisions on suspension of hospitals have remained unimplemented or ignored by PhilHealth,” the senator said.

Zubiri referenced the cases against the Perpetual Succor Hospital and General Santos Doctors Hospital ghost patient schemes, with the former’s case having no movement and the latter’s hearing being put on hold.

“Paano natin maaayos ang katiwalian sa PhilHealth kung wala namang kaso na fina-file at wala pong mga taong ikinukulong? Kung ganito ang pangyayari diyan sa loob ng PhilHealth,” the senator asked. Carlito P. Topacio