Release of P326-M compensation to SPMC followed ‘due process’ – PhilHealth exec

DAVAO CITY (MindaNews / 13 August) – The release of P326 million in compensation from the interim reimbursement mechanism (IRM) of the Philippine Health Insurance Corporation (PhilHealth) to the Southern Philippines Medical Center in Davao City went through “due process,” the agency said as it denied speculations that favoritism and corruption attended such procedure.

Dr. Hector Zenon Leonardo P. Malate, PhilHealth-Davao acting regional vice president said in a statement issued on Thursday that all of its releases in the region followed the existing rules and regulations of the state-run insurer on the provision of IRM funds.

He said IRM was adopted “to respond to unanticipated events such as a pandemic.”

Malate said that the COVID-19 pandemic did not only cause sickness but also disrupted the economy, affecting operations of private and government entities, including that of Philhealth, which necessitated the release of IRM funds to sustain the operations of healthcare facilities amid the outbreak.

He explained that IRM is not solely intended for COVID-19 treatment but also for other health-related services, including but not limited to dialysis, chemotherapy and maternity benefits as the “current health crisis affected everyone.”

He added the IRM funds in the region were released based on the applications made by facilities and subsequently passed all requirements, to ensure patients who need the assistance from PhilHealth, be they COVID-19 patients or not, can avail of medical services.

“This pre-payment mechanism is needed to ensure that despite the disruptions, sufficient funds are available so that healthcare facilities continue to operate and serve patients,” he said.

A tarpaulin bearing safety reminders on COVID-19 is posted outside the SPMC in Davao City. MindaNews file photo

Malate noted that the 1,500-bed SPMC is the country’s largest government hospital catering to patient-referrals from all regions outside Davao.

He added the government hospital is the biggest COVID-19 referral hospital in Mindanao.

The region’s three COVID-19 referral hospitals are SPMC, Davao Regional Medical Center in Tagum City, and Davao Doctors Hospital’s Dumoy facility in Davao City.

“As with all other releases, the amount of IRM funds released to SPMC was based on the hospital’s 90 days annual historical benefit claim and have undergone due process on granting of IRM funds,” Malate said.

PhilHealth’s corporate legal counsel Atty. Roberto Labe Jr. told the Senate in a hearing on Tuesday that SPMC got the biggest share of the IRM funds for COVID-19 patients.

But Labe said all releases of IRM funds were covered with corresponding receipts.

The Senate hearings came after former PhilHealth anti-fraud legal officer Thorrson Montes Keith accused PhilHealth officials of pocketing around P15 billion through pocketed some P15 billion through allegedly fraudulent schemes, including the distribution of IRM funds and the procurement of information technology system.

PhilHealth has denied Keith’s allegations.

In a phone interview on Wednesday, Dr. Ricardo Audan, SPMC chief of clinics and health emergency also dismissed as “very much baseless” the controversy involving the P326-million compensation the hospital received from PhilHealth.

Audan said the 1,500-bed hospital, considered the country’s biggest government hospital, would need to pour in huge resources to sustain its operations to support not only the treatment of COVID-19 patients but also the basic needs of its medical frontliners.

He said a “mega-hospital” like SPMC needed to pool in resources because it attracts a number of patients from several parts of Mindanao.

From March 16 to August 10, Audan said the hospital spent around P94 million for its COVID-19-related operations, including the treatment of suspects, probables and confirmed cases numbering around 3,250, many of whom also came from other regions of Mindanao.

He added that the hospital has around 5,000 employees.

Aside from the treatment of its COVID-19 patients, Audan said the hospital might even need additional budget since it also provides support to its medical workers to ensure that they survive through this pandemic.

“I think with this COVID, and you know, ang mamahal din kasi ng PPEs din (PPEs are very expensive). I think we still need a budget because other than the patients, we also provide our frontliners with accommodation, food, transportation, so hindi lang ang patients pati din ang mga employees namin (not only patients but also our employees who are) frontiers they are also provided with PPEs — everything,” he said.

As of Wednesday, he said the SPMC has 179 admitted COVID-19 patients.

He added it was not surprising if the SPMC received the biggest budget because the government hospital’s collections and transmission for Philhealth surpassed that of other hospitals in the country.

“That’s not surprising because by history – from the start — malaki na yung collections namin sa Philhealth and transmission malaki din (our collections for Philhealth were big, and so was our transmission).

The SPMC ranked first in terms of collections in 2007 and 2015, according to Audan.

He added that SPMC’s collections reached P1.2 billion in 2018, surpassing the 2015 collections of P1 billion, through the hospital management’s more aggressive strategy in enrolling clients in Philhealth.

“We were no. 1 in terms of collections, both private and public nationwide in 2007. In  2015, we were also no. 1 because we collected P1 billion, and in 2018, we collected P1.2 billion. Why is this so? We were very aggressive in our campaigns — our Philhealth strategy – particularly in  2018, if you have no Phiheallth, we will have you enrolled ourselves,” he said.

He said the SPMC also expanded its services for kidney, heart and cancer treatments.

“We have expanded our services and we are considered a mega-hospital throughout the Philippines. When you are a ‘mega-hospital,’ you will get many patients for that matter,” he said.

In a statement, Presidential spokesperson Harry S. Roque said that the Palace found “nothing irregular” in the PhilHealth’s IRM allocation for SPMC.

“Per DOH (Department of Health), it is the biggest hospital facility in the country as a government hospital. Last year, the hospital total admissions are 76,586. There are also 586,278 outpatients in the same period,” he said.

He added the 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,” he said.

He said the SPMC has the highest PhilHealth income.

“Its average income for 2018 to 2019 was P1.2-B and IRM is based on the monthly average or the track record of reimbursement for 2018-19,” he added.

The official said SPMC has the biggest amount of claims due to its regular provision of healthcare services to patients all over Mindanao. (Antonio L. Colina IV/MindaNews)