Gwen: Covid isolation facilities now a lucrative business 

CEBU CITY, Philippines—Cebu Governor Gwendolyn Garcia has been publicly raising reports, alleging irregularities of the coronavirus disease 2019 (COVID-19) claims from the state’s health insurance corporation.

The latest involved isolation facilities for patients infected with COVID-19. 

Garcia, in a press conference on Tuesday, February 9, 2021, described the opening and operating of quarantine and isolation facilities for COVID-19 patients as a ‘lucrative business’. 

“Isolation centers now are lucrative business. Because who wanted to spend P22,449 to feed and house a patient within 10 days?” said Garcia in a mix of Cebuano and English.

Garcia was referring to the Community Isolation Benefit Package issued by the Philippine Health Insurance Corporation (PhilHealth), which is often referred to as the CCIBP. 

Based on PhilHealth Circular No. 2020-0012 that provided guidelines for community COVID-19 isolation centers, PhilHealth can only reimburse up to a maximum of P22,449 per claim. 

The memo, signed by former PhilHealth president Ricardo Morales, was issued on April 8, 2020. 

It also stated that operators of isolation facilities can file reimbursement claims for their discharged patients “after providing all mandatory services”. 

“The claims from government health care facilities shall be utilized to cover all services, medicines and diagnostics provided for in this Circular and other operating expenses to support delivery of care, including hiring of additional personnel, internet subscription, service provider subscription fee and IT hardware. Any remaining fund may be utilized for incentives for human resource involved in its operation with sharing based on internal guidelines,” the memo said. 

According to Garcia, however, the reimbursed money will not be granted directly to the patients but to the individuals manning the quarantine centers. 

“This is why the more there’s an increase of people who tested positive meant there’s more who will be isolated. It’s a lucrative business if the number of COVID positive patients continue to rise,” said Garcia in Cebuano. 

Under the Availment of CCIBP section of PhilHealth Circular No. 2020-0012, it stated that all Filipinos are eligible to receive the benefit. 

“To avail of the benefit, the beneficiary must meet the clinical and/ or social criteria as stated in the applicable issuances of the DOH (Department of Health),” PhilHealth added. 

However, the memo also barred individual beneficiaries from directly filing a claim. 

“Claims shall be paid to the CIU (community isolation unit) through the facility who filed for the claim. Payments for services rendered and applicable payment terms, whether for claims processing and/ or diagnostics and commodities support, shall be negotiated and settled between the CIU and its partner facilities,” it explained. 

Last May 2020, Garcia first claimed that government officials and hospital executives connived to take advantage of PhilHealth’s COVID-19 claims to get higher reimbursements.

Months after the governor made her report, the National Bureau of Investigation in Central Visayas (NBI-7) charged officials of PhilHealth here (PhilHealth-7) and Perpetual Succour Hospital Inc., a private hospital in Cebu City, for allegedly committing fraud through an upcase.

Upcase is the term used to define a fraudulent practice, usually faking reports to show that the patient’s condition has worsened to claim higher reimbursements. 

NBI-7 also accused PhilHealth-7 anew, and Chong Hua Hospital, for conniving to produce fake documents as means to justify COVID-19 claims of a deceased patient who, based on their investigation, was never infected. 

Read: PhilHealth, Chong Hua officials charged for fraud in COVID claim

The embattled state-ran health insurance firm has been facing controversies and backlash after reports of wide-scale corruption were made public. 

/bmjo