PhilHealth suspends IRM amid corruption allegations

The Philippine Health Insurance Corporation (PhilHealth) has suspended the implementation of the Interim Reimbursement Mechanisms (IRM) with hospitals amid allegations of corruption in the program.

In a statement on Thursday, August 13, the state health insurer said, "PhilHealth vowed to find ways to make the IRM more responsive to the needs of healthcare facilities affected by the current pandemic to assure patients of continuous access to needed health services."

However, it would "review its overall implementation and resolve issues arising from congressional inquiries."

The IRM – which has emerged as an alleged source of politicking and corruption in the state health insurer – is a program that advances the reimbursement of members' insurance claims to hospitals and clinics directly hit by "fortuitous events," supposedly cutting the long lines and tedious bureaucratic process.

IRM shares were computed based on hospitals' historical claim or the average daily claim from the previous year multiplied by 90, which should approximate the amount the medical facilities would need for 3 months.

The Senate hearing on Tuesday, August 11, so far revealed disparities in IRM releases.

Of 33 healthcare institutions in Western Visayas claiming their IRM share, 32 have yet to receive it. In Batangas, 3 COVID-19 referral hospitals have received less than 70% of their allotment. In Eastern Visayas, 10 public hospitals were still waiting for their IRM share as of Tuesday.

The Southern Philippines Medical Center in Davao City received the highest share of all hospitals in the country – P326 million – even if the Davao region which it served ranked only 6th among regions with the highest number of COVID-19 cases. (READ: PhilHealth justifies biggest COVID-19 reimbursement for Davao City hospital)

The dialysis clinic chain B. Braun Avitum already received P45 million in April, even if it does not handle COVID-19 patients.

Senators slammed the "palakasan" or "favoritism" in IRM releases, but PhilHealth denied any irregularity. (READ: Favoritism? Senators slam ‘inequitable’ PhilHealth advanced payment scheme)

After two Senate hearings. some senators had called for the suspension of IRM.

The House of Representatives is conducting separate hearings on alleged corruption in various aspects of PhilHealth's operations. – Rappler.com

Bonz Magsambol

Bonz Magsambol is a multimedia reporter for Rappler, covering health, education, and social welfare. He first joined Rappler as a social media producer in 2016.

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