PhilHealth processes members’ transactions in Quezon City. Maria Tan, ABS-CBN News/File

MANILA — The Commission on Audit (COA) found issues in the data of over a million senior citizens enrolled in the membership database of the Philippine Health Insurance Corporation (PhilHealth), including thousands of deceased members still on the list.

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In its annual audit report, the COA flagged the state-run health insurer for "deficient" process controls in its membership data collection and management of its 8.5 million enrollees which resulted to several issues.

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The audit team found that 1,335,274 or 15 percent of enrolled beneficiaries had "incomplete and erroneous data entry" in the PhilHealth Members Information System (MIS).

Among the incomplete or erroneous details noted in MIS include:

• Encoding of only middle initial instead of middle name (1,254,136 entries)

• No middle names encoded (70,931 entries)

• Misspelled names (328 entries)

• Not encoding the first or second name (5 entries)

• Suffix not encoded in the right field (9,874 entries)

"The enrollment of members without middle names, with middle initials only, with last names consisting of only one letter, and with other irregularities and errors increases the risk of double or multiple entries per member since the matching validation is programmed to detect only an absolute match of entries contained in the database," the COA said.

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State auditors recommended and PhilHealth agreed to direct all provincial and regional offices to verify and correct the problematic entries.

PhilHealth said it is already doing a monthly clean-up of database inaccuracies, while also conducting annual re-orientation or refresher training on encoders.

The state-run health insurer said it will aims to deploy the PhilHealth Member Portal with online registration and changes in the fourth quarter of 2024.

"As a rejoinder, the Audit Team has commended Management for its efforts in implementing the audit recommendations. Nevertheless, the updates and further compliance with these recommendations will be monitored and validated in the succeeding audit," it said.

MORE THAN 266,000 DUPLICATE ENTRIES

In 2020, COA already flagged PhilHealth for duplication in members' records. The same deficiencies were observed upon review of the 2023 list of senior citizens.

Three years later, it found the same problem and 266,665 duplicate or multiple entries equivalent to P1.333 billion state subsidy that government had to shoulder.

Under the law, premium contributions of enrolled senior citizens shall be sourced from Republic Act No. 10531 or the Sin Tax Law.

"Assuming that out of the 266,665 enrolled SC members with multiple entries, 133,332 or half are the unique or original data, the estimated minimum overbilling made by PhilHealth to the NG [national government] at P5,000 per member would be P666.660 million," the report stated.

"The amount could have been significantly higher due to the presence of multiple entries as noted in Table 78 where instead of P5,000 for one SC member, P20,000 or four times was billed to the NG," it added.

The COA stressed that the duplicate or multiple entries not only overstate the billing of premiums, but may also mislead PhilHealth and the public to "the actual number of beneficiaries already covered in the NHIP [National Health Insurance Program]" and measurement of PhilHealth's actual performance and accomplishment.

In response, PhilHealth said it will not include similar sounding names in the list of billings to DBM but will be  endorsed to provincial and regional offices for rectification.

PhilHealth likewise said it will update the criteria for the extraction of the list.

OVER 4,000 DEAD SENIORS STILL ON THE LIST

State auditors flagged PhilHealth for the inclusion of 4,062 deceased senior citizen members in its membership database and billings to the Department of Budget and Management for 2023.

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COA said this "exposed the Corporation to the risk of generating inaccurate or unreliable data and possible payment of fraudulent claims." 

The audit team sent letters to 250 health care institutions (HCIs) to request the list of deceased patients. As of December 31,2022, only 63 HCIs responded.

Verification of the data showed 3,616 senior citizen members tagged as deceased from 2019 to 2022 were still in the database.

"It is emphasized that the 63 respondents represent only 3.41 percent of PhilHealth's total 1,846 accredited hospitals as at July 31,2023 as indicated in the PhilHealth website, not to mention those who died outside hospitals. Thus, the aggregate number of deceased SCs in the database can be prevailing, given that only a percentage was considered in our validation," the COA said.

State auditors said the non-updating of the status of the 4,062 deceased senior citizen members resulted in the oversubsidy from the national government worth P18.080 million. COA said this amount could have been used for other important vital government projects.

PhilHealth said PSA has already returned to PhilHealth death information of 661,533 out of 5,422,197 members already updated in the database.

The state-run health insurer committed to complete the updating of the database by July 2024.

PhilHealth likewise requested the list of dead senior citizen members noted by the Audit Team for proper validation.

"The Audit Team commended Management for the significant efforts exerted in the updating of the PhilHealth database, as well as its proper. Coordination with the PSA. Nonetheless, the completion of the updating of PMD will be monitored in the succeeding audit," the COA said in its rejoinder.

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