PhilHealth pinuna ng COA sa data management mess na nagresulta sa ‘oversubsidy’

MANILA, Philippines- Natuklasan ng Commission on Audit (COA) ang mga isyu sa data ng mahigit sa isang milyong senior citizens na naka-enroll sa membership database ng Philippine Health Insurance Corporation (PhilHealth), kabilang na rito ang pananatili sa listahan ng libo-libong namatay na mga miyembro.

Sa annual audit report nito, isiniwalat ng COA ang “deficient” process controls ng PhilHealth sa membership data collection at management nito na 8.5 million enrollees na nagresulta ng ilang isyu.

Natuklasan ng audit team na ang 1,335,274 o 15% ng enrolled beneficiaries ay may “incomplete and erroneous data entry” sa PhilHealth Members Information System (MIS).

Kabilang sa mga incomplete o erroneous details na nakasulat sa MIS ay ang mga:

• Encoding of only middle initial instead of middle name (1,254,136 entries)

• No middle names encoded (70,931 entries)

• Misspelled names (328 entries)

• Not encoding the first or second name (5 entries)

• Suffix not encoded in the right field (9,874 entries)

“The enrollment of members without middle names, with middle initials only, with last names consisting of only one letter, and with other irregularities and errors increases the risk of double or multiple entries per member since the matching validation is programmed to detect only an absolute match of entries contained in the database,” ayon sa COA.

Ang rekomendasyon ng COA na sinang-ayunan naman ng PhilHealth ay ang atasan ang lahat ng provincial at regional offices na iberipika at itama ang mga ‘problematic entries.’

Sinabi ng PhilHealth na ginagawa na nito ang monthly clean-up ng database inaccuracies, habang nagsasagawa na rin ng annual re-orientation o refresher training sa mga encoder.

Ayon sa PhilHealth, layon nito na i-deploy ang PhilHealth Member Portal kasama ang online registration at pagbabago sa fourth quarte ng 2024.

“As a rejoinder, the Audit Team has commended Management for its efforts in implementing the audit recommendations. Nevertheless, the updates and further compliance with these recommendations will be monitored and validated in the succeeding audit,” anito.

Matatandaang taong 2020, pinuna rin ng COA ang PhilHealth para sa pagdodoble ng record ng mga miyembro nito. Parehong deficiencies o pagkukulang din ang naobserbahan nang rebyuhin ang 2023 list ng mga senior citizens o lolo’t lola.

Matapos ang tatlong taon, natuklasan ang parehong problema at 266,665 duplicate o multiple entries na may katumbas na P1.333 billion state subsidy na kailangang balikatin ng gobyerno.

Sa ilalim ng batas, “premium contributions of enrolled senior citizens shall be sourced from Republic Act No. 10531 or the Sin Tax Law.”

“Assuming that out of the 266,665 enrolled SC members with multiple entries, 133,332 or half are the unique or original data, the estimated minimum overbilling made by PhilHealth to the NG [national government] at P5,000 per member would be P666.660 million,” ayon sa ulat.

“The amount could have been significantly higher due to the presence of multiple entries as noted in Table 78 where instead of P5,000 for one SC member, P20,000 or four times was billed to the NG,” ang sinabi pa rin ng COA.

“he duplicate or multiple entries not only overstate the billing of premiums, but may also mislead PhilHealth and the public to “the actual number of beneficiaries already covered in the NHIP [National Health Insurance Program]” and measurement of PhilHealth’s actual performance and accomplishment,” ayon pa rin sa Komisyon.

Bilang tugon, sinabi naman ng PhilHealth na hindi nito isasama ang kaparehong magkatunog na pangalan sa ‘list of billings’ sa DBM subalit ieendorso sa provincial at regional offices para sa pagwawasto.

Gayunman, sinabi naman ng PhilHealth na ia-update nito ang criteria para sa pagtanggal sa listahan.

Samantala, pinuna rin ng COA ang PhilHealth para sa pagsama sa 4,062 deceased senior citizen members sa membership database at billings sa Department of Budget and Management para sa taong 2023.

Sinabi ng COA na ito’y naging daan para ma-expose ang “Corporation to the risk of generating inaccurate or unreliable data and possible payment of fraudulent claims.”

Nagpadala naman ang audit team ng liham sa 250 health care institutions (HCIs) para hilingin ang listahan ng mga deceased patients. Hanggang noong Disyembre 31, 2022, mayroon lamang 63 HCIs ang sumagot.

Makikita sa beripikasyon ng data na 3,616 senior citizen members na natukoy na patay na mula 2019 hanggang 2022 ang nananatili sa database.

“It is emphasized that the 63 respondents represent only 3.41 percent of PhilHealth’s total 1,846 accredited hospitals as at July 31,2023 as indicated in the PhilHealth website, not to mention those who died outside hospitals. Thus, the aggregate number of deceased SCs in the database can be prevailing, given that only a percentage was considered in our validation,” ang sinabi ng COA.

Winika ng COA na ang non-updating ng status ng 4,062 deceased senior citizen members ay nagresulta ng oversubsidy mula sa national government na nagkakahalaga ng P18.080 million. Tinuran ng COA na ang nasabing halaga ay maaaring gamitin para sa ibang mahalagang proyekto ng pamahalaan.

Sinabi naman ng PhilHealth na updated ng ibinalik ng PSA ang PhilHealth death information ng 661,533 mula sa 5,422,197 members,

Nangako ang PhilHealth na kukumpletuhin nito ang paga-update sa database noong nagdaang July 2024.

Hiniling din ng PhilHealth sa Audit Team ang ‘proper validation’ ng listahan ng mga patay ng senior citizen members.

“The Audit Team commended Management for the significant efforts exerted in the updating of the PhilHealth database, as well as its proper. Coordination with the PSA. Nonetheless, the completion of the updating of PMD will be monitored in the succeeding audit,” ang sinabi ng COA sa rejoinder nito. Kris Jose