MANILA, Philippines — Some doctors and officials of Philippine Health Insurance Corp. (PhilHealth) are getting from the state insurance firm P16,000 to P32,000 for each “ghost” treatment, former Health Secretary Janette Garin said on Wednesday.
Garin said PhilHealth had been paying for treatments of fictitious patients not only for kidney ailments but also for pneumonia and dengue.
“Paperwork is prepared for a lot of the people who have no ailments. The documents are submitted to PhilHealth to make it appear they are sick so payments can be collected,” she said in a press briefing in Quezon City.
President Rodrigo Duterte demanded on Monday the courtesy resignation of PhilHealth officials days after the Inquirer published a three-part investigative report about fictitious patients, PhilHealth losses amounting to billions of pesos due to overpayment and fraud, and a “mafia” behind the padded claims.
The owner of WellMed Dialysis Center who has been accused of pocketing P808,600 in spurious health insurance claims was arrested on Monday.
WellMed vice president Bryan Christopher Sy, along with other executives of the center, was charged with estafa and falsification of documents in the Department of Justice (DOJ) on Tuesday. Sy has denied the allegations.
Garin said the people who were tapped in filing fraudulent claims with PhilHealth were provided with food and transportation fare.
“They are happy to be given P500 each. But the hospital, in cahoots with doctors and PhilHealth officials, collect around P16,000 and sometimes P32,000 per ghost treatment,” she added.
In a phone interview with the Inquirer, Garin said doctors and health providers would offer food to senior citizens but would report to PhilHealth that the seniors were treated for pneumonia.
She claimed that certain health providers had been forced to take part in filing the bogus claims. “If you can’t beat them, join them.”
The former health chief recounted that PhilHealth was also funding treatments of fake cataract surgeries in 2006.
“In 2006, I exposed many cataract surgeries in Region 6 (Western Visayas) … There were fatalities. Unfortunately many documents that we demanded from PhilHealth appear to be missing,” she said.
Sy will remain in detention at the National Bureau of Investigation. He was arrested on Monday while undergoing investigation for allegedly filing dialysis claims for dead patients that were eventually paid by PhilHealth.
On Tuesday, the DOJ and the Manila Regional Trial Court (RTC) rejected his petition to be released and instead upheld his warrantless arrest by the NBI.
Later that day, Senior Assistant State Prosecutor Anna Devanadera ruled that Sy would remain in detention until she decides whether to charge him in court for estafa and falsification of documents.
Habeas petition denied
His lawyers had argued that he could not be arrested without a court warrant since his alleged offenses were based on documents and could not be considered a “continuing crime,” a ground for warrantless arrest.
In denying Sy’s petition to be freed, Devanadera cited the decision of Judge Marivic Balisi-Umali of Manila RTC Branch 20 on Tuesday afternoon denying the habeas corpus petition filed by Sy’s wife, Therese Francesca Tan-Sy, and affirming the validity of his arrest.
“It appears from the letter of the National Bureau of Investigation that the attending physicians of WellMed have committed and continue to commit schemes to defraud PhilHealth,” since WellMed continued to file claims for dead patients, Umali said in her letter.
She ruled that Sy was detained “by virtue of a judicial process defined as a writ, warrant (or) subpoena.”
“That there is no probable cause of the warrantless arrest of the subject has been held not a valid ground for the issue of a writ of habeas corpus,” she added.
Therese, a WellMed purchasing officer, is one of the respondents in the NBI complaint. Others were Dr. John Ray Gonzales, WellMed medical director; Claro Sy, chair; Alvin Sy, corporate treasurer; Dick Ong, administration officer; and physicians Porshia Natividad and Joemie Soriano.
The charge sheet also included former assistant manager Edwin Roberto and employee Liezel Aileen De Leon, who reported the clinic’s alleged malpractice to PhilHealth.
Former presidential spokesperson Harry Roque, who acts as lawyer for the two whistleblowers, said his clients would ask to be placed under the DOJ’s witness protection program.
Talking to reporters after the inquest, Roque said PhilHealth officials should have been included in the charge sheet.
Garin, meanwhile, appealed to Health Secretary Francisco Duque III to take over PhilHealth until a new board is constituted.
Garin also said Duque, with the political will of Mr. Duterte, could help reform PhilHealth.
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