THE National Bureau of Investigation (NBI) in Davao Region has started investigating around 90 Philippine Health Insurance Corporation (Philhealth)-affiliated hospitals and doctors in the region even before the Philhealth's Interim Reimbursement Mechanism (IRM) issue broke out early August this year.
In an interview on Tuesday, September 1, 2020, with Geraldo P. De Luna, NBI-Davao Special Investigator III who is tasked to investigate Philhealth anomalies, he revealed that the NBI received the request for investigation for the 90 hospitals and doctors on July 11, 2019 from Ruben John A. Basa, former Philhealth's chief operating officer and executive vice president.
De Luna also revealed that their investigation during that time was not fast-tracked because former Philhealth president and chief executive officer (CEO) Ricardo Morales immediately issued a memorandum order to all Philhealth regional offices that all requests of documents from any Philhealth offices should be coursed through their central office in Manila.
The memorandum order was dated September 2019.
Philhealth-Davao, meanwhile, said it will air its side regarding the matter soon.
De Luna said these cases were not IRM-related but mostly were "upcasing."
Upcasing is when doctors or the hospitals upgrade the diagnosis of a patient to get larger Philhealth claims. For example, when the patient is only suffering from common colds, the doctors or hospitals would diagnose it as community acquired pneumonia because the latter has a larger Philhealth benefit amount.
"Sa upcasing, wala namang makukuha ang doctor niyan kasi may fixed professional fee sila, so ang hospital lang (meron)," De Luna said.
Meanwhile, he also revealed that there is one hospital or doctor in the region who is being investigated for an IRM-related case but it has already submitted its counter-affidavit or has replied to explain the allegation hurled against it.
He added that after the Senate inquiry on Philhealth IRM issue and the creation of the task force to investigate Philhealth anomalies by the Department of Justice which the NBI is a part of, Philhealth has loosen its grip on the documents needed by the investigating body.
"Wala nang problema at naging cooperative naman po ang Philhealth sa mga imbestigasyon ngayon," De Luna said.