News Archive 2003
Fraudulent Insurance Claims Draining Filipino Medicare Fund - December 2, 2003
By JAY B. HILOTIN Staff Reporter (Gulf News)
Conmen may be getting help from scheming insiders to siphon off cash from fund managed by Overseas Workers Welfare Administration
Dubai Conmen using fraudulent insurance claims may be eating away the estimated 3.5 billion peso ($63 million) Medicare fund intended for Filipino over- seas workers and their relatives.
Criminal elements have been seen behind the false claims from the fund managed by Overseas Workers Welfare Administration (OWWA), with possible collaboration by scheming insiders.
It is not known how much OWWA has lost to bogus medical claims but a ranking official is reportedly now on a "floating" status over the anomalous Medicare fund disbursements.
Consultation
But Reynaldo N. Dalma Jr, a visiting senior vice president of
Philippine Health Insurance Corp (PhilHealth), told Gulf News
that the planned transfer of OWWA-Medicare to PhilHealth will
help plug those holes.
Community leaders here said they are not against the transfer itself but also decried the lack of consultation.
Dalma, in transit here from Cyprus, also met Filipino community leaders last night to dispel OFWs' fears about the planned transfer of their Medicare funds. "We don't know how much the scamsters have taken from the OFWs' Medicare fund. OWWA has yet to show an audited financial report. A thorough audit would show what's really going on," said Dalma, a certified public account who worked with the American Insurance Group affiliate PhilAmLife in Manila for over a decade before he joined the government in 1998.
Dalma
is on a mission to consult OFWs on the planned transfer of
OWWA-Medicare to PhilHealth, a 44-billion-peso ($800 million)
national health insurance programme.
"We put a lot of safe guards, with both internal and external auditors. We have our in-house actuary to ensure the fund is well managed," he said, outlining some of the benefits of the transfer.
Philippine Labour Secretary Patricia Sto Tomas and new OWWA administrator Virgilio Angelo were re cently alarmed by the anomalies in the disbursement of the OWWA- Medicare fund and have asked the Philippine National Police to investigate the matter.
"We don't know how much the scamsters have taken from
the fund. OWWA has yet to showan audited fmancial report. A
thorough audit would show what's really going on."
Reynaldo N. Dalma Jr.
Senior official of PhilHealth
False claims
Angelo suspects the possible penetration by crimi- nal elements
of the agency's Medicare benefit system, which has resulted
in Medicare benefit claims running to millions of pesos.
Acting on an anonymous tipoff, OWWA governing board members led by Sto Tomas looked into two sample cases involving claims of up to 306,000 pesos ($5,563) which they both found to be fraudulent.
She said investigators checked with the doctors involved and
found that the supposed patients never even came to her for
consultation.
Sto Tomas and Angelo did not name erring officials but said
they are looking in- to the possible involvement of a former
OWWA employee who may have been assisted by someone from within
the organisation.
Angelo promised a swift and thorough probe.
OFWs, non-governmental organisations (NGOs) and the Department of Labour and Employment (Dole) have objected to the transfer of the OWWA- Medicare fund to Phil- Health.
Dalma's visit here came after Dr Francisco Duque, President of PhilHealth, vowed to conduct consultations with overseas workers.
Sto Tomas objected to the transfer because she wanted part of the OWWA- Medicare funds to remain with the OWWA.
She said Dole is formulating a health plan where some funds would remain with OWWA for rehabilitation expenses.
For example, Sto Tomas said, if a worker's limb is cut off, PhilHealth will answer for the actual medical care and the OWWA- Medicare fund could be tapped to create a prosthesis for the severed limb.
Dalma also said an earlier letter of PhilHealth's Duque to President Gloria Arroyo was "taken out of context".
Critics flayed Duque who said the transfer would benefit President Macapagal-Arroyo's re-election bid in 2004.
President Gloria Arroyo ordered the transfer last February through Executive Order 182, which she later recalled following OFW's resistance.
Migrants' advocates in- stead urged that the OWWA board be reconstituted to include more OFW representatives.