The president and chief executive officer (CEO) of the Philippine Health Insurance Corp. (PhilHealth) on Friday announced that organizational changes would be effected to curb alleged corruption in the state-owned health insurance system.
In a news conference in Quezon City, PhilHealth chief Ricardo Morales said officials of the agency would be “rotated” to stamp out an alleged mafia that is behind the corruption in the agency.
Meanwhile, he added, they would leave complaints filed against former and current PhilHealth officials with investigators.
“This so-called mafia has already agreed to be rotated. We already talked, I consulted with them (members) and we agreed that they are going to be rotated,” Morales said.
He, however, clarified that the rotation was not a punishment, but a part of normal operation of any large corporation whether in the private or government sector.
“Hindi nanggaling sa PhilHealth ‘yung term (mafia) na ‘yan (That term did not come from PhilHealth), but if it’s anything significant, they (past and present PhilHealth officials) have already been, they are already marked for rotation,” Morales said.
Roy Ferrer, former PhilHealth president and CEO, and former board member Roberto Salvador Jr. earlier told a Senate hearing that there were eight senior PhilHealth officials involved in defrauding PhilHealth of billions of pesos.
Former Malacañang spokesman Harry Roque on Thursday filed graft charges before the Ombudsman against Ferrer and Salvador and other former and current PhilHealth officials, describing them as members of the alleged mafia.
“So far, all those identified eight executives [who are said to belong to the] mafia, there’s no evidence so far of corruption or wrongdoing [against them],” Morales said.
He added that these executives were no longer connected with the organization and were now private individuals.
Another case was filed by the National Bureau of Investigation (NBI) on Wednesday against 21 PhilHealth executives involving “ghost” dialysis claims.
Lolita Tuliao, one of the respondents and speaking on behalf of all 21 tagged in the complaint, said they “vehemently deny the accusation” and “cry foul” that their names had been released to the media even before the charges reached them.
She added that they were denied due process.
Tuliao said the NBI appeared to have copied the names from a document that they had submitted without proper investigation or verification and even wrongly naming her as a doctor when she was not.
Morales said they were also implementing other measures to prevent corruption, incompetence and inefficiencies by finding and addressing weaknesses within the system.
PhilHealth Senior Vice President Jojo del Rosario said they had been implementing the Machine Learning Identification, Detection and Analysis System (Midas) since 2018 to detect possible fraud in hospitals and other facilities.
Del Rosario explained that the Midas system could detect anomalous transactions through outliers in trends such as high claims or rise in the number of diseases with no epidemic.
From data analyzed in the past five years, there have been about 100 anomalous cases that are being investigated and three hospitals accused of anomalous transactions and whose accreditations have been recommended to be withdrawn.