Garin: Fix 'fraud virus' in PhilHealth before Universal Healthcare rollout

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Metro Manila (CNN Philippines, June 13) — The Philippine Health Insurance Corp. (PhilHealth) must clean up its ranks and install reforms to fix an internal "fraud virus" hounding the agency ahead of offering additional services to the public, former Health Secretary Janette Garin said Thursday.

Garin exposed a supposed "mafia" within the state-run health insurance firm, saying that recent reports of ghost dialysis treatments are just the "tip of the iceberg." These dirty schemes could also put the fate of the recently-signed Universal Healthcare (UHC) Law in peril.

"Maganda 'yung batas but it will not deliver what it is meant to deliver dahil ang paglalagyan nating opisina has a big problem in the first place," Garin told CNN Philippines' The Source.

"Maganda 'yung UHC law. However, hindi niya maa-achieve 'yung kaniyang intensyon if you rely solely on Philhealth, because Philhealth itself is rotting inside," she added.

Signed in February, the law makes all Filipinos mandatory members of PhilHealth. Members may avail of free diagnostic services, consultation fees, and medical tests and secure funding aid for certain diseases.

Garin once handled PhilHealth as secretary of the Department of Health from 2015-2016 during the time of President Benigno "Noynoy" Aquino III. She said the recently-exposed scheme of WellMed Dialysis and Laboratory Center of filing claims for unused sessions follows the same modus used for eye cataract benefits back in 2015.

Whistleblowers of the scandal said that PhilHealth lost ₱154 billion because of these fake dialysis claims. Bryan Sy, one of the owners of WellMed, has been charged for allegedly filing bogus PhilHealth claims worth ₱800 million.

READ: PhilHealth sues dialysis center, admits widespread 'ghost treatments'

Garin said the mafia has since grown bigger to cover up the "collusion" within the agency. She also pointed out that the scheme has been recurring within PhilHealth as reforms she had put in place during her term were reversed by her successor, ex-Secretary Paulyn Ubial.

"Unfortunately, upon the change of the PhilHealth president and the new board, all these came back again," Garin said. "I was surprised that the reforms we did were all overturned, and it was not only limited to cataract. There were a lot of abuses in terms of dialysis, ceasarian section, pneumonia, even dengue."

For one, the "stop payment" scheme which automatically cuts off PhilHealth reimbursements to hospitals and healthcare facilities with red flags as well the annual review of accredited providers were dropped by the succeeding executives.

Now a returning Iloilo representative, Garin said she will push for a bill that will make the "stop payment" rule permanent, as well as put criminal liability on the officials heading hospitals and clinics that take advantage of PhilHealth claims. Erring healthcare providers and their board members may also be blacklisted from PhilHealth's accredited facilities if proven involved in fraud.

The agency can also outsource contribution collections so that the figures are not manipulated, she added.

READ: Duterte asks PhilHealth chief, board members to submit courtesy resignations 

Garin also wants Health Secretary Francisco Duque to take over PhilHealth and take advantage of President Rodrigo Duterte's political will to pursue reforms.

Duterte has said that he wants doctor-businessman Jaime Cruz to lead PhilHealth. Garin said his business knowledge will bode well in assessing the finances of the insurance firm.