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COA’s latest findings show lack of technical leadership in PhilHealth

Metro Manila (CNN Philippines, December 7) – The latest findings of the Commission on the audit regarding questionable advances made by the Philippine Health Insurance Corp. amounting to 14.97 billion yen at different hospitals proved the lack of technical leadership within the agency amid a health crisis, a House of Representatives leader said. Tuesday.

Speaking to CNN Philippines’ Source, Deputy Minority Leader Stella Quimbo said Congress has long questioned PhilHealth’s interim reimbursement mechanism or cash advance program for hospitals even before it was suspended last year and before even the publication of the COA’s 2020 report.

Citing last year’s Congressional deliberations, Quimbo said the mechanism was previously used by PhilHealth to help hospitals affected by Super Typhoon “Yolanda” in 2013 since the MRI system was initially intended to prepay patients. affected health establishments for their insurance claims.

“But for some reason they used that same basis for COVID-19 payments last year and sabi namin, wala namang nasirang ospital in the case of COVID-19 so bakit ito ang ginawa nilang base? (we said no hospitals were physically damaged in the COVID-19 case, so why did they use it as a base?) And true enough, the COA, 16 months later, validated our hypothesis saying that illegal communication with MRI“said Quimbo.

PhilHealth is only supposed to provide funding to healthcare facilities that have been directly affected by “fortuitous events” with a clear and apparent intention to operate on an ongoing basis, according to PhilHealth Circular 2020-0007.

COA said in its 2020 report that PhilHealth has released funds to 711 public and private hospitals for services that have yet to be rendered, contrary to Presidential Order 1445 or the Philippine government’s audit code.

“Yun ang difference between the conclusions of Congress and the conclusions of the ACO, but basically, pareho has a basic conclusion on the legal basis of its legal basis,” said Quimbo.

[Translation: That’s the difference between the findings of Congress and the findings of COA but basically the basic conclusion is the same that there was no legal basis to release the funds.]

Quimbo said the issue only proves that PhilHealth needs to outsource experts from the private sector, which will improve the institution’s technical leadership, as private health insurance companies do not encounter such irregularities.

She also pointed out that PhilHealth seems to have moved from one extreme situation to another, because while it has become “liberal” in terms of paying some hospitals, it has not been able to facilitate unpaid debts from other institutions until. what they have to try to disengage from state health insurance.

RELATED: PhilHealth Has Over $ 86 Billion In Unpaid Hospital Claims

“For me, kulang talaga (they’re really missing), I’m thinking about technical leadership, ”she said.

“We have to recognize that you really need a certain level of skill na baka wala pa sa gobyerno, baka kailangan talaga I subcontract to the private sector (who are probably not yet in government, they may need to outsource it to the private sector) “, added the MP.

Quimbo renewed its call for the passage of House Bill 7429, which aims to contract out segments of PhilHealth to the private sector. The bill has been pending before the House Committee on Health since August 2020.