A persistent lack of transparency and accountability has contributed to the financial troubles being faced by the Philippine Health Insurance Corporation (PhilHealth), Senator Sonny Angara said today.
Angara noted that the Commission on Audit (COA) issued a disclaimer of opinion for 2018 on the fairness of the presentation of PhilHealth’s financial statement due to questions about the benefits claims expense and doubts about the accuracy of the collections made by the corporation.
COA also noted that it could not establish the accuracy of PhilHealth’s restated financial statement for 2017 because it was not supported with complete and relevant documents.
Addressing PhilHealth Fund Management Sector SVP Renato Limsiaco Jr. during the Senate’s committee of the whole hearing on the controversies surrounding the state health insurer, Angara aired his frustration at the failure of the institution to shape up in spite of the repeated adverse findings issued by COA.
“Basically, what the COA has been saying for many years now is PhilHealth has not been transparent because mayroon siyang mga understated or overstated income. Tapos yung benefit payments hindi supported,” Angara said.
“Kung pribadong kumpanya ito at paulit-ulit na adverse ang findings sa financial statements ninyo, sinibak na kayo ng nakaupo dyan, matagal na. If you look at the previous accounting scandals involving big corporations, pag may eskandalo sa financials, pag may fraud, sinisibak yan, hinihingi ng shareholders yan tsaka ng board of directors,” he added.
In the case of PhilHealth, Angara said the requirement of accountability should even be higher considering that public funds are at stake.
“And yet the same actors are still in place and that’s why I’m wondering; kasi kung sa akin lang, kung pribadong korporasyon ito, matagal na nasibak yung mga taong in charge dyan sa mga financial statements,” Angara said.
Angara welcomed the decision of COA to conduct a special audit on PhilHealth, which he has been pushing for in response to the controversies that have emerged in recent months.
He urged the state auditing firm to include the Interim Reimbursement Mechanism being used by PhilHealth for settling claims on COVID-19 cases by health facilities to determine if the process is fair and aboveboard.
Numerous allegations have been made about how PhilHealth seems to be favoring some facilities over others, including those that do not even cater to COVID-19 patients.
During last Tuesday’s hearing, Angara also noted how the claims for pneumonia recorded a sudden jump from less than P3 billion a year in 2009 to 2011 to P9.7 billion in 2015. From 2017 to 2019, claims for pneumonia have averaged at P10.5 billion a year.
PhilHealth Legal Sector SVP Rodolfo del Rosario Jr. noted that the firm has performed data analytics on various cases including pneumonia and found that “it is highly improbable for some areas to have a sudden increase in pneumonia” and that the report “points to upcasing in those particular areas.”
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