Anti-corruption body finds ‘systemic insurance fraud’ in PhilHealth

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Metro Manila (CNN Philippines, August 1) — A “systemic flaw” at the Philippine Health Insurance Corporation has fueled a cycle of fraud in the beleaguered agency, the Presidential Anti-Corruption Commission said on Saturday ahead of the submission of the results of its investigation to President Rodrigo Duterte.

The PACC, one of the presidential offices looking into alleged irregularities at PhilHealth, will submit a partial report to Malacañang on Monday, Commissioner Greco Belgica said in an online media briefing. The probe began in May following reports of PhilHealth's alleged overpricing of COVID-19 test kits.

“There’s really a systemic flaw sa sistema ng PhilHealth kaya napakahirap. Parang paulit-ulit, hindi matigil ang corruption. Kasi basically insurance fraud e,” Belgica said.

[Translation: There’s really a systemic flaw in PhilHealth’s system that’s why it’s difficult. Corruption seems to be a cycle which can’t be stopped. It’s basically insurance fraud.]

Belgica said the report is partial because "further investigation" is needed after the PACC uncovered loopholes and identified PhilHealth officials who are "vulnerable for these kinds of corruption."

Belgica flagged PhilHealth’s information technology system and legal services as a major issue with several “defects.”

Hindi kino-correct ang systems ng pag-report nila. Kaya withdrawal lang ng withdrawal ang mga – whether it is hospitals or patients na manloloko sa PhilHealth. Tapos ang PhilHealth parang bulag… talagang nabulag na sila,” Belgica said.

[Translation: The systems of reporting are not being corrected. That's why hospitals and patients involved in defrauding Philhealth just keep on withdrawing money. PhilHealth seems blind…they’re really blind now.]

He suspects that these schemes may have gone unresolved because PhilHealth officials also profit from them.

Belgica said he could not disclose further details since the report will have to be formally submitted to the President.

The Senate is also set to investigate PhilHealth next week, after allegations of corruption, incompetence and inefficiency supposedly led to the controversial resignation of anti-fraud legal officer Thorsson Montes Keith. PhilHealth President and CEO Ricardo Morales denied the accusations.

Duterte has since directed Undersecretary Jesus Melchor Quitain from the Special Assistant to the President’s office to launch another probe on the issues hounding PhilHealth.

READ: PhilHealth under probe, denies widespread corruption alleged by resigned officer