PhilHealth confirms paying for ghost kidney treatments

MANILA, Philippines — The Philippine Health Insurance Corp. (PhilHealth) yesterday confirmed that the agency has been defrauded and paid claims of dead kidney patients but clarified these have been properly investigated and those involved charged.

At a press conference, PhilHealth president Roy Ferrer said at least 28 counts of misrepresentation and falsification were filed against WellMed Dialysis and Laboratory Center Corp. before the courts.

He added that PhilHealth also filed cases against doctors who were possibly involved in such anomaly that occurred since 2016.

“Under its present leadership, PhilHealth would not let thievery, in any form, to prosper. Not on my watch,” Ferrer stressed.

He pointed out that under his term, PhilHealth initiated various reforms to facilitate claims evaluation and to deter fraud.

“Efforts are currently being intensified to cleanse the ranks of officials and employees out to destroy PhilHealth’s reputation and gains,” he also said.

Ferrer expressed suspicion that members of the so-called “mafia” in PhilHealth who were affected by the cleansing effort were behind the exposé of the ghost kidney treatments.

A former WellMed employee reported that the medical facility has been filing claims for dialysis sessions on behalf of patients who have already died.

The employee, Edwin Roberto, sought the help of lawyer Harry Roque who sponsored the Universal Health Care (UHC) Act when he was still a party-list representative. It was also Roque who accused PhilHealth of not taking immediate action on Roberto’s complaint.      

Ferrer denied Roque’s accusations, saying some of the suspended PhilHealth middle managers have been trying to destroy his image so he would be removed as head of the agency. A total of 38 PhilHealth employees were allegedly already suspended for different violations.

He also said that WellMed appeared to be not the only medical facility embroiled in fraudulent claims that possibly involve PhilHealth officials and employees.        

He revealed at yesterday’s press conference that at least 19 dialysis centers are undergoing investigation, aside from a number of doctors.

“There are fraudulent claims, but we cannot just make it public and castigate them because we need to gather evidence,” Ferrer told the media.

PhilHealth chief legal officer Rodolfo del Rosario said they have established that WellMed filed fraudulent claims and that the agency has stopped paying claims since February.

He added that PhilHealth has been receiving numerous complaints and that his office is investigating about 2,000 health providers.

Despite the irregularities, Ferrer gave assurance that PhilHealth is financially stable with an P11.6-billion fund.

As of last month, PhilHealth paid a total of P47.2 billion in claims as compared to P38.4 billion during the same period last year.