51 hospitals received P1.5-B IRM funds despite fraud cases

By Filane Mikee Cervantes

August 17, 2020, 2:54 pm

<p>House Committee on Public Accounts chair and Anakalusugan Rep. Michael Defensor </p>

House Committee on Public Accounts chair and Anakalusugan Rep. Michael Defensor 

MANILA – Around 51 hospitals with fraud-related cases have received Interim Reimbursement Mechanism (IRM) funds amounting to almost PHP1.5 billion from the Philippine Health Insurance Corp. (PhilHealth).

House Committee on Public Accounts chair Michael Defensor made the claim during a joint inquiry with the House Committee on Good Government and Public Accountability into the alleged corruption in PhilHealth.

Defensor said PhilHealth has released a total of PHP1,493,554,124.55 to 51 healthcare institutions across the country despite fraud cases against these hospitals have yet to be resolved.

"Ang pinagtataka ko bakit hindi ni-resolve ang fraud cases bago nag-release ng IRM? (I am wondering why these fraud cases were not resolved first before releasing the IRM?)," Defensor said.

Defensor, citing PhilHealth records, noted that 4,664 fraudulent cases have been reported from 2013 to 2020.

These offenses include padding of claims, post-dating of claims, extending the period of confinement, misrepresentation by furnishing false or incorrect information, unjustified admission beyond accredited bed capacity, unauthorized operations beyond service capability and fabrication or possession of fabricated forms.

"With so many hospitals here in Metro Manila, in other provinces, we should not allow those that have fraud cases, those that have penalties, to continue to have such funds," he said.

IRM is an advanced payment scheme that authorizes PhilHealth to give healthcare institutions cash in advance to respond to unanticipated events like natural disasters and calamities.

On Thursday, PhilHealth announced the suspension of IRM to pave way for a review after the release of payments to hospitals for Covid-19 services had been marred by supposed irregularities.

PhilHealth pledged to look for ways to make IRM “more responsive to the needs of healthcare facilities affected by the current pandemic to assure patients of continuous access to needed health services.”

The state insurer, nevertheless, ensured that its members can still avail of Covid-19 packages and other benefits. (PNA)