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3 HIV-related questions (plus sub-questions) to ask re the PhilHealth scam

Every PLHIV is allocated P30,000 per year. As of April 2019, 37,091 PLHIVs are on treatment. Multiply that by P30,000 per person (per OHAT Package/coverage), and the amount involved here is P1,112,730,000. Too much money involved for us not to ask how the money is getting spent.

Here are the facts:

  • As early as last year, two former employees of WellMed Dialysis Center already reported that it has been forging signatures of patients who have long died to file claims from the Philippine Health Insurance Corporation (PhilHealth) from 2016-2018.
  • Typical in the Philippines (e.g. think of Napoles, PDAF, fertilizer scandal, et cetera), this was soon “forgotten” (or at least not as widely covered anymore particularly by mainstream media, so not gaining traction with the public). That is, until June, when the Philippine Daily Inquirer detailed the scam (again) via an investigative report.
  • Still in June, President Rodrigo Duterte said he would “reorganize” PhilHealth after the agency lost some P154 billion to “ghost” patients and deliveries.
  • WellMed Dialysis Center’s accreditation was (finally) withdrawn in June. But in a privilege speech, Sen. Panfilo Lacson alleged that PhilHealth continued to pay WellMed Dialysis Center even after its accreditation was suspended because of its involvement in a scam.
  • A hearing was started by the Senate Blue Ribbon Committee (chaired by Richard Gordon) to look at the allegations of corruption in the Department of Health (DoH), and – yes – PhilHealth.

Now why is this issue important to PLHIVs and those in the HIV advocacy in the Philippines?

Aside from the fact that there may be LGBTQIA Filipinos who may also be needing dialysis, the money that actually pays for the “free” treatment and antiretroviral medicines of Filipinos living with HIV come from PhilHealth.

No, darling, you don’t get “free” meds; a PLHIV is expected to enroll in PhilHealth before he/she can access the treatment. Meaning, YOU are paying for your treatment via your P2,400 (if voluntary) PhilHealth contribution. Anyone who tells you the meds are “free” is hiding the truth from you, or is outright lying to you.

And so the talk about stealing P154 billion should be an issue to PLHIVs and those serving them; particularly since it is not rare to encounter service providers who say that they can only offer shitty (and often lacking) TCS (treatment, care and support) services because there’s no money available (DUH!).

Every PLHIV is allocated P30,000 per year. As of April 2019, 37,091 PLHIVs are on treatment. Multiply that by P30,000 per person (per OHAT Package/coverage), and the amount involved here is P1,112,730,000.

Now off my head, here are a few questions that should also be asked as we tackle the PhilHealth scam (and questions that particularly touch on HIV in the Philippines).

1. Does PhilHealth monitor the use of the OHAT package, or they solely rely on reports that can – apparently, as the case of WellMed Dialysis Center highlighted – be faked/made up? Can individuals access the individual reports filed for them (on the use of their OHAT package)? If there’s none, why not? If these can be accessed, are there mechanisms to question the same?

These questions have to do with whether a PLHIV actually uses his/her allocation.

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The Outpatient HIV/AIDS Treatment (OHAT) Package covers: drugs and medications; laboratory examinations based on the specific treatment guideline including Cluster of Differentiation 4 (CD4) level determination test, viral load (if warranted), and test for monitoring anti-retroviral (ARV) drugs toxicity; and professional fees of providers.

But in 2015, when interviewed by Outrage Magazine, PhilHealth’s Medical Specialist III and Millennium Development Goals Benefit Products Team Head Dr. Mary Antoinette Remonte said that “it has come to our attention that some treatment hubs charge for some laboratory tests, even after the release of the OHAT Package circular.” And so while the circular may specifically mention covered items, the same circular should not be taken too literally.

For instance, VL is not included in the circular, but if a PLHIV needs “viral load, if it’s really needed, they can still charge it on the OHAT package. Any laboratory tests related to ART treatment, they can use the OHAT Package for it.” For Remonte, “even if viral load testing was not written in the first circular, it was already included in the coverage.”

2. The baseline tests are still not specified in the circular/OHAT Package. This is why many PLHIVs are lost to TCS – i.e. they are told to pay for their own tests (e.g. chest X-ray, CBC) before they can get their hands on the life-saving meds (the ARVs). Why is this idiotically still not included in the OHAT Package, and even knowing that (many) PLHIVs won’t end up consuming the P30,000 allocated them anyway?

3. Do they also withdraw the accreditation of treatment hubs/clinics/satellite clinics that claim the P30,000 even if they did not actually use the entire amount for the use of the PLHIV? Has there ever been a service provider that lost its accreditation because of non-delivery of services?

We have spoken with PLHIVs who were told to get lab tests outside of their treatment hubs (e.g. chest X-ray, VL, CD4 count); they were told to pay for the same. No, they may NOT use their OHAT Package for the same, a handful of them were told. They have to shell out their OWN money.

The thing is, if these are already supposedly covered by PhilHealth, why the additional expenses? Who then benefits from the OHAT Package? The service providers not offering the services and yet getting the money? Isn’t this theft? And if one thinks so, what are the mechanisms for complaining? Are there any at all?

Let’s be blunt here: If these are not answered, here’s another avenue where profiteering is happening via PhilHealth, and at the expense of PLHIVs.

To end, let me state this to stress this: Every PLHIV is allocated P30,000 per year. As of April 2019, 37,091 PLHIVs are on treatment. Multiply that by P30,000 per person (per OHAT Package/coverage), and the amount involved here is P1,112,730,000.

Too much money involved and yet service providers still often saying “there’s no money” to help PLHIVs…

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