‘Implement, don’t suspend Universal Health Care law’

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Metro Manila (CNN Philippines, June 11) — A former official of the state health insurer and one of the authors of the Universal Health Care law said that the measure should be fully implemented amid a call for its suspension after allegations of insurance fraud surfaced.

“I won’t agree with the suspension kasi [because] this will deprive a hundred million Filipinos who are actually benefiting from Universal Health Care law,” doctor Anthony Leachon, a former independent director of the Philippine Health Insurance Corporation (PhilHealth) told CNN Philippines’ The Source on Tuesday.

Former Presidential Spokesperson and former Kabayan party-list Rep. Harry Roque, one of the authors of the measure, also balked at the proposal to suspend the implementation of the law. He said the new law will roll out reforms in the state health insurer.

Mas importante rin ‘yung structural reforms lalo na doon sa adjudicatory procedure nila. Mali ‘yan kasi that ultimately everything is handled by the PhilHealth — from investigator, prosecutor and judge. Kaya nagkakaroon ng kuntsabahan kasi sila-sila naman lahat ‘yan eh,” said Roque, who serves as lawyer for two PhilHealth fraud whistleblowers.

[Translation: Structural reforms are more important, especially in their adjudicatory procedure. It’s wrong that ultimately everything is handled by the PhilHealth — from investigator, prosecutor and judge. That’s why there’s connivance because it’s all the same people.]

The law cuts the PhilHealth Board of Directors from 15 members to 13 and requires that it includes three experts in public health, management, finance and health economics.

It also requires that the PhilHealth president and chief executive officer have seven years of experience in the same fields.

Leachon said the full implementation of the UHC law could solve PhilHealth’s woes on fraudulent insurance claims, which prompted President Rodrigo Duterte to ask its acting president, Roy Ferrer, and other members of its Board of Directors to resign.

Malacañang said the resignation would “allow an uninfluenced investigation of the reported irregularities.”

Senator-elect Christopher “Bong” Go, a longtime aide of Duterte, said he will suggest to the chief executive to suspend the implementation of the UHC law amid a scandal surrounding the state health insurer, where it lost funds due to fraudulent insurance claims.

At the center of the controversy is Quezon City-based WellMed Dialysis Center, which supposedly claimed benefits for patients that have already died or claimed more than what patients used. WellMed has denied these allegations, which came from two of its former employees.

The issue has elicited concern among legislators on the implementation of the new law, which would increase benefits to PhilHealth members. For one, it would provide 120 free dialysis treatments from just 90.

“Pinasa natin itong batas na ito para makinabang ang taongbayan, hindi para lalong tumaba ‘yung mga baboy diyan sa PhilHealth,” Roque said.

[Translation: We passed this law so that the people would benefit from it, not to fatten further the pigs at PhilHealth.]

‘Group crime’

With PhilHealth’s top officials seen to exit at the behest of the President, Malacañang said the state health insurer would temporarily be headed by second-level officials as the investigation rolls out.

Go also said Monday that he will recommend that Duterte completely revamp PhilHealth and put employees in plantilla positions on floating status to allow the new head of the state health insurer a "free hand" to pick new employees.

He also hinted that there is mudslinging among lower-ranking PhilHealth officials, especially among regional vice presidents from Visayas and Mindanao, which could be the reason behind why fraudulent insurance claims go unchecked.

Ang nakikita ko [What I see] is they belong to a different culture and set of attitudes and behaviors eh. And suddenly, a new set of well-meaning leaders are trying to do some reforms,” Leachon said. “Change is not easy in a huge organization like the PhilHealth.”

Ferrer had said that there may be a “mafia” in the state health insurer targeting him because of his focus against fraud.

But for Roque, it is not enough that Ferrer assures that there are measures against fraud.

“Stop saying that you’re dealing with it because actually they persist. And one of the things we discovered in Congress nga is it’s the same old people who are even approaching providers na mayroon nang stop payment orders and asking them for 25% of amount involved so they can be paid,” Roque said.

Leachon said that when it comes to insurance fraud, everyone from PhilHealth employees, to healthcare providers, hospitals, employers and even patients are likely involved.

“A crime of this magnitude is always a group crime,” he said.

CNN Philippines Correspondent AC Nicholls contributed to this report.