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Quimbo urges PhilHealth: Junk hospital reimbursement scheme

DEPLORING the Interim Reimbursement Mechanism (IRM) as marred by corruption, Marikina Rep. Stella Quimbo said the scheme should be dropped by the Philippine Health Insurance Corp or PhilHealth.

Quimbo stressed that some hospitals are using the system for non-COVID patients.

Quimbo said IRM was adopted for COVID-19 response and if not used properly it will drain the funds of the PhilHEalth.

“Lumalabas sa liquidation reports mula mismo sa Philhealth na 458 hospitals/clinics ang nakapag liquidate na ng IRM. Ang problema rito, 346  or 75 percent ng mga hospitals/clinics na nakapagliquidate na, wala ni isang COVID patient ang kasama sa na serbisyuhan nila,” Quimbo said during the investigation of the House committee on public accounts.

“Zero COVID claims sa halagang 1.2 billion pesos na nakuha ng 346 hospitals/cllinics mula sa IRM! Nakakabahala dahil marami sa kanila, lagpas kalahati na ng released IRM ang nagamit na para sa non-COVID claims,” she added.

Based on the data presented by PhilHealth, at least seven hospitals were given IRM for non-COVID cases.

Because of this Quimbo filed a motion to withdraw the PhilHealth policy on IRM.

The motion was adopted by the panel  conducting an inquiry into the alleged irregularities at PhilHealth.

“Kitang-kita na hindi natupad ang layunin ng IRM na tulungan ang mga COVID patients, kung ang malaking bahagi ng pondo ay nagagamit din para sa non-COVID claims.  The misuse of the IRM funds in allowing it to be used for non-COVID cases will lead to the displacement of COVID patients requiring hospitalization, and possibly contributing to the spread of the virus,” Qumbo lamented.

PhilHealth senior vice president Dr. Israel Pargas agreed with the adopted motion of the House joint panel.

“Technically under review naman nga siya para ma-check yung kasama yung suspect and probable kasi nung una kasama nga siya,” he said.

Contempt

In the same hearing, the joint panel of the good government and public accountability and public accounts have cited in contempt PhilHealth Internal Legal Department Senior Manager Rogelio Pocallan Jr., and ordered his detention at the House of Representatives until Monday.

Cavite Rep. Elpidio Barzaga Jr. made the motion  after it was revealed that Pocallan rendered the legal opinion that was used as basis for the PhilHealth board’s decision to overturn a Court of Appeals ruling suspending Perpetual Succor Hospital, Inc. in Cebu for three months.

The PhilHealth board instead penalized the hospital with a P100,000 fine, and restitution of all benefits unnecessarily paid by PhilHealth.

Barzaga said Pocallan should be cited in contempt for supposedly “misleading the public” that a court ruling can be reversed by an administrative agency like PhilHealth,.

In his response, Pocallan clarified that his legal opinion was for a different case, but maintained that the PhilHealth board has “quasi judicial powers” to penalize.

The joint house panels will also ask the National Bureau of Investigation to conduct a probe and look into possible plunder charges over allegedly unclaimed PhilHealth refunds from a hospital amounting to P170 million.

This stems from the supposed overpayment of PhilHealth to the Hospital Management Incorporated, former operator of Cardinal Santos Medical Center.

Barzaga also questioned PhilHealth’s failure to get a conviction in most criminal cases it filed.