By Nancy Carvajal
The National Bureau of Investigation (NBI) has recommended the filing of criminal cases against several hospitals and dialysis centers over the supposed erroneous computation of reimbursements by the Philippine Health Insurance Corporation (Philhealth), which amounted to over P4 billion.
A report by the NBI National Capital Region showed inconsistencies in how the Philhealth, under then- Chief Executive Officer Ricardo Morales, computed the amount due to the hospitals and dialysis centers under the interim reimbursement mechanism (IRM).
“Based on the investigation conducted by agents of NBI-NCR, it was revealed that Philhealth disregarded rules in approving and releasing IRM Fund,’’ the report read.
NBI’s investigation revealed that Philhealth released P27 billion to the hospitals under IRM, which was P4 billion more than what they were supposed to get based on receipts.
“The IRM fund must be based only on historical paid claims which if properly computed should only have been P23 billion,’’ the report read.
NBI agent John Bacho, who is working on the case, said Philhealth also failed to organize a team to validate the hospitals’ claims.
“The validation was necessary to assess the effects of COVID-19 pandemic and properly determine the percentage of allowable IRM fund to be granted to the requesting HCIs (healthcare institutions),” the report read.
The Department of Justice has tasked the NBI to investigate the alleged anomalies in Philhealth. Cases have earlier been filed against Morales and a number of former and incumbent Philhealth officials over the supposed misuse of the state health insurer’s funds.