Imee: Legal Loophole Abetting Philhealth’s ‘Pera Sa Pneumonia’ Scam

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Senator Imee Marcos has recommended to withhold some P10 billion in Philhealth funds not directed for the testing and treatment of COVID-19, until the state health care insurer submits a detailed accounting of its fund releases.

Marcos said Philhealth may be evading a comprehensive audit of its fund releases by taking advantage of a loophole in Republic Act 11332, or the law requiring that “notifiable diseases” be reported to the government.

Marcos explained that the law excludes pneumonia from the definition of a notifiable disease, “allowing the band of vultures in Philhealth to ignore a detailed accounting of pneumonia cases that are being used by hospitals to claim reimbursements through a bill-and-bribe scheme.”

“The legal loophole and the failure of Philhealth to submit a detailed breakdown on hospital claims abet the ‘Pera sa Pneumonia’ scam that involves overstated or false claims, like the upcasing of a common cold to pneumonia and the treatment of ghost patients,” Marcos said.

Pneumonia has consistently been among the top diseases for which Philhealth has been releasing funds since the past administration until the present surge of the COVID-19 pandemic.

Philhealth has failed to submit a breakdown on hospital claims despite the Senate’s request for the data last year, Marcos noted, adding that municipal health offices and the Commission on Audit itself must also be provided the crucial information.

Marcos has filed Senate Bill 1416 to amend R.A. 11332, so that pneumonia is specifically identified as a notifiable disease and reportorial requirements are strengthened during pandemics and public health emergencies.

Marcos has also recommended to suspend the collection of premiums by Philhealth, among the options government can take to plug the agency’s loss of billions in membership contributions and government subsidies to “the band of vultures in Philhealth.”

The government can also create an account where existing funds can be parked for safekeeping and temporarily transfer procurement of Philhealth supplies to the Department of Budget and Management, while sorting out the financial mess that has plagued Philhealth for decades, Marcos added.