PhilHealth, hospital deny alleged irregularity in COVID-19 claim

CEBU, Philippines —  The Philippine Health Insurance Corporation (PhilHealth)-7 and Adventist Hospital-Cebu (AHC) have denied allegations they are involved in alleged irregularities of a patient’s claim of benefits.

The Office of the Ombudsman is now looking into these charges that stemmed from a National Bureau of Investigation (NBI)-7 probe into a “randomly forwarded and approved PhilHealth claim” of AHC when a death certificate of a patient was allegedly made to appear the patient was COVID-19 positive despite test results saying otherwise.

PhilHealth said it has always abided by guidelines in processing claims.

“In view of the recent allegations of NBI-7, Philhealth-7 sticks to its previous statement that it continues to abide by the guidelines in processing claim documents per published circulars which are developed by its policy-making sector and are approved by the Philhealhealth Board,” reads the agency’s statement signed by its Regional Vice President, Edwin Oriña.

Oriña said PhilHealth Circular 2020-0009 entitled “Benefit packages for inpatient care of probable and confirmed COVID-19 developing severe illness/outcomes” that was published on April 14, 2020 in a national newspaper was the basis of the regional office in processing claims.

The circular is based on the Philippine Society of Microbiology and Infectious Diseases (PSMID)’s “Interim Guidelines on the Clinical Management of Adult Patients with suspected or confirmed COVID-19 infections version 2.1 as of March 31” in 2020, and the World Health Organization guidelines.

In a separate statement, AHC said it is confident that its hospital staff and physicians performed their duties and responsibilities with utmost truthfulness and benevolence and in accordance with updated guidelines set by PhilHealth.

It is certain that PHIC claims underwent stringent processes in strict conformity to the criteria and guidelines of PhilHealth.

“Had the attending physician been given the chance to explain the clinical/medical management, her sound expertise and professional judgment could have strongly shed light to the investigation,” the statement reads.

The hospital said it is disheartened that NBI-7 released a public announcement on the alleged fraudulent PHIC claim and alleged connivance without furnishing it a copy of the formal complaint and giving it the opportunity to refute the accusations.

It said it will file a counter-affidavit once it receives a copy of the complaint filed before the Ombudsman.

AHC said it is dedicated to supporting the government in flattening the curve of the COVID-19 pandemic.

“The administration and staff of AHC have bravely rallied together in battling this unseen foe despite of uncertainties, physical threats, mental and emotional stress, especially among the one-third of its workforce were contracted with the virus,” its statement reads.

Charges

NBI-7 filed criminal and administrative complaints against eight officials of PhilHealth-7 and six personnel of AHC.

The charges include alleged violation of the Anti-Graft and Corrupt Practices Act and for malversation of public funds or property.

The NBI also charged the eight PhilHealth-7 officials and personnel with dishonesty, neglect of duty, misconduct, inefficiency and incompetence in the performance of official duties and conduct prejudicial to the service in violation of Executive Order No. 292 or the Revised Administrative Code of 1987.

The same officials and personnel are also facing charges for violation of R.A. 6713 or the Code of Conduct and Ethical Standards of Public Officials and Employees.

The patient, a retired bank employee, was admitted to AHC on May 27, 2020 for cough and shortness of breath.

The patient died the following day and the attending physician allegedly issued a certificate of death stating that the patient died of “COVID pneumonia probable, severe.” However, results of the antibody test and RT-PCR test result turned out negative for COVID-19. – JMO (FREEMAN)