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Bolster PhilHealth anti-fraud mechanisms — Angara

SENATOR Sonny Angara has called for strengthening the anti-fraud mechanisms of the Philippine Health Insurance Corporation (PhilHealth) to rid the institution of wastages due to corruption or inefficient systems.

Apart from pushing for the conduct of a special audit on PhilHealth funds following the most recent controversy faced by the state health insurer involving its allegedly overpriced information technology system and interim reimbursement mechanism (IRM), Angara noted the weaknesses in the firm’s anti-fraud mechanisms that has subjected its funds to abuse and misuse by some unscrupulous groups and individuals.

Angara said it is high time for PhilHealth to digitize its records and to utilize systems to validate membership claims just like what is being used by pension funds Social Security System and Government Service Insurance System.

This was part of Angara’s recommendations as contained in a letter to Senate President Vicente Sotto III as the presiding officer of the Committee of the Whole that recently conducted hearings on the controversies surrounding PhilHealth.

“They (PhilHealth) should likewise look into strengthening their manpower complement by hiring more medical reviewers, anti-fraud officers, data scientists, data analytics personnel, and even experts in artificial intelligence and big data,” Angara said in his letter.

The need for PhilHealth to immediately digitize its records was highlighted during the Senate hearings where now resigned PhilHealth president and CEO Ricardo Morales disclosed that there are about 5,000 members who are 130 years old and that nobody knows if they are dead or alive.

Earlier this week, a television network reported a very much alivefsenior citizen was told that he was already dead for almost four years already based on his PhilHealth member data record.

Angara has been pushing for the digitization of both the government and private sector as part of the national digital transformation program to improve efficiency in the delivery of services and prepare the country for the requirements of a rapidly changing world.

This is contained in Senate Bill 1470 of the proposed National Digital Transformation Act, which Angara filed last May 4.

Publication Source :    People's Journal
Marlon Purificacion
Journalist At Large