PhilHealth proposed IT fund would've 'significantly' reduced fraud: Morales

ABS-CBN News

Posted at Aug 04 2020 06:01 PM

MANILA - PhilHealth president and CEO Ricardo Morales said Tuesday he focused on improving the agency's information system to upgrade the agency's "inadequate" anti-fraud mechanism.

PhilHealth board member Alejandro Cabading earlier said Morales and other high-ranking officials approved the purchase of overpriced equipment and software.

Morales said the agency's whistleblower policy was "weak and inadequate" for an organization that deals with tens of thousands of claims daily.

"The IS (information system) would have provided a net that would have significantly reduced fraud in PhilHealth. Ang problema po sa IS maliit po ang budget. That is the main reason it has failed," he said during the Senate's investigation into alleged corruption in the agency.

(The problem with the IS is it has a small budget.)

"Marami pong fraud na nangyayari sa PhilHealth. Ang estimate nga ho is about 7.5 percent ng total benefit payments ang nawawala sa fraud... Inadequate ho ang anti-fraud mechanism ng PhilHealth for the size of its operations."

(There are many fraud being done in PhilHealth. We estimate about 7.5 percent of total benefit payments is lost to fraud... PhilHealth's anti-fraud mechanism is inadequate for the size of its operations.)

PhilHealth senior vice president and chief information officer Jovita Aragona said the agency complies with the standard process of making IT strategic plans laid down by the Department of Information and Communications Technology (DICT).

Her department, however, encountered a "chicken and egg" problem during the budget proposal, Aragona said.

The board of directors required the approval of the DICT before it would endorse an amendment to the expenditure plan, but the DICT said it needs the endorsement of the board before approving the amendments, Aragona said.

"Yung flagrantly inserted daw, hindi naman po yun totoo and hindi approved ng DICT. Eh yung proseso nga, ipapa-approve namin, but we’re seeking the approval of the board," she told senators.

(The claim that we flagrantly inserted items and that it was not approved by DICT is not true because we're seeking the approval of the board.)

The issue may only be resolved when the department "satisfactorily" responds to the results of the internal audit, according to Dr. Susan Mercado, expert panel member of PhilHealth's board of directors.

"They gave us a budget that was not scrutinized. We really could not in conscience give it a go-signal," she said.

Sen. Risa Hontiveros, meantime, said the issues could have been addressed with the "enforcement of the existing internal and external control mechanism within PhilHealth."

"Wag naman nating gawin taunang tradisyun ng Senado, wag naman sanang kailanganin na magimbestiga sa PhilHealth tuwing buwan ng Agosto," she said, referring to last year's Senate probe into dialysis centers' fraudulent claims to the state insurance agency.

(Let's not make this a Senate tradition that every August senators investigate PhilHealth.)

Hontiveros proposed the creation of a price negotiation board for a big project such as a "robust, integrated, and harmonized data management system" of PhilHealth.

"Bilang isang author ng Universal Healthcare Law, kinikilala ko po ang papel ng PhilHealth para sa tagumpay ng universal healthcare. Bahagi ng pagkilalang iyan ay malaking expectation na gawin ng PhilHealth ang kaniyang responsibilidad at protektahan ang pondo para sa kalusugan ng pangkalahatan," she said.

(As an author of the Universal Healthcare Law, I recognize PhilHealth's role in its success. Part of this recognition is a huge expectation for PhilHealth to do its responsibility and protect public health funds.)