Panibagong mga pasabog ang ibinunyag ng tatlong matataas na opisyal ng Philhealth na tumestigo na rin sa isinasagawan imbestigasyon ng Task Force PhilHealth.
Sa statement na ipinadala ni Department of Justice (DoJ) Usec. at Spokesman Markk Perete, kabilang sa mga ito sina Senior Vice President at Chief Information Officer Jovita Aragona, Corporate Secretary Jonathan Mangaoang at Acting Senior Manager ng PhilHealth Fact-Finding Investigation and Enforcement Division (FFIED) Ernesto Barbado.
Inamin ni Aragona na hindi raw ma-detect ng kasalukuyang IT system ng Philhealth ang mga fraudelent claims.
Binanggit nito ang segment sa validation process ng ahensiya ay mano-mano pa ring isinasagawa.
Paliwanag ni Aragona, ito ay dahil sa kabiguan ng mga kinauukulang opisina sa Philhealth na matukoy ang kinakailangang internal control systems noong ginagawa pa lang ang disenyo at dini-develop ang IT systems ng ng Philhealth.
Nilinaw ni Aragona na ang dating isyu ng mga kinikuwestiyong pagbili ng mga swith ng Philhealth ay transaksiyon ng Philhealth office sa National Capital Region (NCR) at dapat daw ay magkaroon ng imbestigasyon sa naturang tanggapan.
Sa panig ni Mangaoang, ang kontrobersiyal na Interim Reimbursement Mechanism (IRM) ay una nang ipinanukala noong January 2020 para masiguro ang financial viability ng mga ospital at mga medical establishments sakaling magkaroon ng emegencies fortuitous events.
Inaprubahan aniya ng Philhealth Board ang IRM base sa opinyon ng legal sector ng Philhealth.
Kinumpirma din ni Mangaoang ang pag-apruba ng Board sa rekomendasyon ng Protest and Appeals Department ng Philhealth Corporation na magbigay ng amnestiya sa mga ospital na late nakakapaghain ng kanilang mga claims para sa reimbursement mula 2011.
Sa ilalim ng batas na lumikha sa Philhealth, hindi pinapayagan ang reimbursement ng clamis na lagpas sa 60-araw mula nang madischarge sa ospital ang pasyente.
Ipinasisilip naman ni Barbado sa Task Force ang ghost o fake claims na una nang inimbestigayan ng FFIED.
“Aragona admitted to the inability of the current IT systems of PhilHealth to detect fraudulent claims. She identified the segments in the corporation’s validation processes that are still done manually. She attributed the current lack of validation mechanism in the corporation’s IT systems to the alleged failure of its relevant offices to specify their required internal control systems during the design and development of the IT systems. She likewise bared the corporation’s plans to develop a more sophisticated IT systems in the future. Aragona also clarified that the previously reported questionable procurement of switches was a transaction of the PhilHealth National Capital Region office. She called for an investigation to be conducted on said office. Meanwhile, Mangaoang stressed that the controversial Interim Reimbursement Mechanism (IRM) was proposed in January 2020 to ensure that hospitals and medical establishments remain financially viable in case of emergencies and fortuitous events. He noted that the PhilHealth Board approved the IRM based on an opinion issued by the corporation’s Legal Sector. Mangaoang likewise confirmed that the Board has approved the recommendation by the corporation’s Protest and Appeals Department to grant amnesty to hospitals that belatedly filed claims for reimbursement from 2011 onwards. The law that created PhilHealth renders ineligible for reimbursement a claim filed beyond sixty (60) days from the discharge of a patient. For his part, Barbado asked the Task Force to look into certain ghost or fake claims previously investigated by the FFIED. Before taking the testimony of these officials, the Task Force agreed to establish composite teams tasked to thoroughly investigate the Information Technology and Legal Sectors of the PhilHealth. The composite teams were directed to, among others, conduct further interviews, gather evidence, conduct audits, and report their findings to the Task Force,” base sa statement na ipinadala ng DoJ.
