STATE AUDITORS have called out the Philippine Health Insurance Corp. (PhilhHealth) for the release of P321.71 million to healthcare facilities in areas affected by last year’s Taal Volcano eruption without proper resolution from its board of directors.
In its 2020 audit report, the Commission on Audit (CoA) said these funds were released to 131 healthcare institutions in Batangas under the Interim Reimbursement Mechanism (IRM) program.
“The absence of a board resolution authorizing the release of funds under the IRM renders the same as legally infirm,” CoA said.
The IRM program is meant for PhilHealth to extend assistance to its members affected by natural disasters, health emergencies, or other unexpected situations.
The PhilHeath management replied in an audit comment that the release of the IRM was “right and just” as the agency had to act urgently following the calamity.
The IRM funds were released to the concerned healthcare institutions in Batangas from Jan. 24 to Jan. 28, 2020, accounting for 50% of all pending claims in these facilities.
However, PhilHealth’s board officially authorized the release of these funds through Resolution No. 2496 that was issued on Jan. 30.
CoA said the early release of funds was contrary to Republic Act (RA) 7875, or the National Health Insurance Act, as amended by RA 10606, which requires the use of health insurance funds to be subject to laws and existing resolutions.
Auditors also questioned why 37 out of the 131 medical facilities were granted IRM funding when these were not directly affected by the volcanic eruption, such as those located in municipalities in Batangas’ 4th district and Batangas City.
These areas were given P116.44 million.
PhilHealth explained that the 4th and 5th districts of Batangas were covered by the funding as they hosted displaced persons affected by the natural disaster.
CoA recommended that the PhilHealth management submit necessary documents that authorized their regional office in CALABARZON to release IRM funds, along with a written explanation on why 37 HCIs received funding, and strictly comply with the National Health Insurance Act.
CoA also flagged the state insurer in its report for making payments worth P14.97 billion under the IRM program to 711 HCIs without any legal basis. — Russell Louis C. Ku