No irregularities in SPMC's P326-M IRM funds

AN OFFICIAL from the Southern Philippines Medical Center (SPMC) denied claims of irregularities in receiving the biggest amount of compensation under the Philippine Health Insurance Corporation's (PhilHealth) Internal Reimbursement Mechanism (IRM) for the treatment of coronavirus disease (Covid-19) patients.

This is in response to the presentation made by PhilHealth legal counsel Roberto Labe Jr. during the Senate investigation on the alleged corruption in the health insurance agency on Tuesday, August 11.

According to Labe's presentation, SPMC got the highest amount of IRM with P326 million. A far second is the UP-Philippine General Hospital (PGH) with P263 million, followed by the Davao Regional Medical Center with P209 million.

The IRM, according to PhilHealth, is a program that advances the reimbursement of members' insurance claims to hospitals and clinics directly hit by "fortuitous events," supposedly cutting the long queue and tedious bureaucratic process.

It was one of the controversial items that came out during the Senate probe. However, some critics of President Rodrigo Duterte claimed there were irregularities in its allocation.

SPMC Finance Officer Barbara Cezar told SunStar Davao in a phone interview that the hospital has the highest PhilHealth income, breaking the billion mark, making SPMC the lone hospital in the country to achieve such earmarks.

She said the hospital's average income for 2018 and 2019 is P1.2 billion, which was the basis for the allocation of the IRM.

Cezar also said the allocated amount was based on the hospital's bed capacity, which had reached 1,500, the biggest in the entire Philippines, both public and private. Cezar said PGH has only around 1,000 beds.

She also cited SPMC has several integrated specialty buildings, which are stand-alone, like the Heart Institute, the Institute for Women and Newborn Care, the Orthopedic and Rehabilitation Institute, the Cancer Institute, the Intensive Care Complex, and the main hospital for General Medicine and Surgery. It has the biggest hemodialysis in the country with 65 dialysis chairs.

"We have no reason to make any fraud on it because we have the data for it," Cezar said, adding they are willing to face any hearing, in case the hospital management will be asked to present their side.

As of August 12, she said the hospital already utilized P307 million from the allotted IRM for Covid-19 patients.

Admittedly, she said the allotted PhilHealth compensation is not enough, and she said they can no longer ask for another round of IRM if it will be depleted.

"Isa pud na sa reason ngano medyo dako atoang gasto for Covid-19 is tungod SPMC is the lone designated Covid-hospital in the city. Maong naa gyud sa atoa naka-admit ang mga Covid-19 patients (One factor why our spending is high, is because SPMC is the lone-designted Covid-19 hospital in the city)," Cezar said.

She added that the hospital also caters to patients outside the region.

Based on their financial report, an average Covid-19 patient has a hospital bill of P300,000. However, there are critical patients, whose admission in the hospital reaches months, has a hospital bill of more than P1 million.

But she said there are few cases of patients, whose bill reaches a million. However, she said they have still reserved financial assistance from the national government worth P100 million.

The SPMC official also belied claims that the huge chunk of IRM share was due to the appointment of its former Chief Dr. Leopoldo Vega, who was appointed by Duterte as Department of Health Undersecretary in June this year.

Vega was also designated as the country's Covid-19 "treatment czar" on July 13.

"Such speculation is false. In the first place, the IRM was already distributed way back in March. Doc Vega was appointed in June. Such allegations are baseless. The allocation of the IRM is based on the hospital's performance," Cezar said.

Meanwhile, she said SPMC is currently addressing the need for more hospital beds, especially for Covid-19 patients. She also said they are adjusting its bed capacity for non-Covid patients.

Health Undersecretary Maria Rosario Vergeire, in a virtual presser, defended PhilHealth's big amount of cash advances given to SPMC, saying it is based on 2019 data of its cash claims from the state health insurer.

Vergeire said the computation of compensation under the PhilHealth's IRM, in which the Davao-based hospital came out with the lion's share, is backed by "historical" documentation.

PhilHealth is an attached agency of the DOH, wherein Health Secretary Francisco Duque III sits as its chairman.

Presidential Spokesperson Harry Roque, in a statement, also defended SPMC's IRM allocation.

"We find nothing irregular in the PhilHealth Interim Reimbursement Mechanism allocation of Southern Philippines Medical Center," Roque said.


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