Pia questions release of PhilHealth's IRM funds to non-COVID cases

Senator Pia S. Cayetano questioned anew what she called the "inaccurate and unauthorized" release of funds for non-COVID cases using the Philippine Health Insurance Corporation's (PhilHealth) Interim Reimbursement Mechanism (IRM).

Citing PhilHealth Circular No. 2020-0007, which authorized the release of standby funds to PhilHealth regional offices to address the COVID-19 pandemic, Cayetano said the IRM funds are supposed to be used for "fortuitous events" - specifically for COVID-19 cases.

The health insurance agency, however, admitted that some funds were released to reimburse health institutions for non-COVID-19 related cases.

"What was the basis in releasing IRM for non-COVID related cases? It's very clear [in my reading], that the objective [of IRM] is 'to provide continuous provision of healthcare services to all Filipinos adversely affected by a fortuitous event'," the senator said, citing the Circular.

"I'm pointing that out because part of the problem here... is unauthorized use. There may not be an intent to deceive, but it is an inaccurate and unauthorized use of the funding as stated in your Circular," she told PhilHealth officials at the Senate inquiry on Tuesday (August 11).

In response, PhilHealth Senior Vice President for legal sector Rodolfo del Rosario said it is the agency's position that the "fortuitous event" referred to the pandemic in general, and the role of PhilHealth in financing healthcare during this time is of "paramount importance."

Cayetano, meanwhile, said there was no question about PhilHealth's intention to continue providing healthcare services to Filipinos during the crisis, but it could have done so using other mechanisms.

"If you wanted to assist [patients with other ailments], you should have assisted them by virtue of a different circular. It should not be [through] this Circular, which was specifically intended for a fortuitous event. [The use of IRM] should be accurate and in line with the objective you intend to address," she asserted.

"The reality is, there is no one... who can understand how you can equate non-fortuitous ailments and consider it as such. That aggravates your problem," she continued.

In last week's Senate inquiry, Cayetano also questioned why PhilHealth allowed the release of the IRM funds to health facilities that have yet to send their reimbursement claims.

She then cited complaints made by some hospitals that while other preferred facilities with questionable circumstances were given funds in advance, the reimbursement claims which they dutifully submitted were returned by PhilHealth due to simple typographical errors.

The sponsor of the Bayanihan to Heal as One Act, Cayetano had repeatedly asked PhilHealth to submit a breakdown of its IRM fund releases through the weekly comments submitted by the senators as part of their oversight on government's responses to the pandemic.