PhilHealth, hospital execs sued

CEBU, Philippines —  Twelve officials and employees of Philippine Health Insurance Corporation in Central Visayas (PhilHealth-7) and a hospital in Cebu City are now facing complaints before the Office of the Ombudsman Visayas.

This after the National Bureau of Investigation (NBI-CEVRO) has filed multiple administrative and criminal complaints against eight officials and employees of PhilHealth and four from Perpetual Succour Hospital in Cebu City with regard to alleged "irregularities" on claims related to the coronavirus disease (COVID-19).

According to NBI-CEVRO’s complaint, the respondents are Arlan Granali, acting regional vice president of PhilHealth-7; Franscis Javier, division chief-HCDMD; Joan Tiu-Ayuson, a medical specialist ; Josette Bacalso, fiscal controller; Reginald Mangubat, medical specialist; Anecito Camahalan Ramas Jr., social insurance officer; Anthonnette Lerios Maamo, clerk; and Keneth Aguilar Donalvo, social insurance assistant.

The cases filed include violation of the Section 3 of Anti-Graft and Corrupt Practices Act (RA 3019), malversation of public funds or property under Article 217 of the Revised Penal Code, violation of EO 92 (Revised Administrative Code of 1987), violation of Section 4 of the Code of Conduct and Ethical Standards of Public Officials and Employees (RA 6713) and gross and grave misconduct.

NBI-7 also filed a complaint against Perpetual Succour officials including Brenda Mondares, finance manager; Gladys Sarmiento, assistant department manager and billing officers Jaye Anne Carcuevas Arañas and Gina Misagal for allegedly violating RA 3019 and malversation of public funds.

“Ang resulta sa investigation showed duna gyud irregularity. Bisa'g dili positive sa COVID, gi-claim nila nga positive. Unya sa part sa PhilHealth, nilusot sa ila ang claim nga COVID. Well, sa tanang ebidensya would show nga dili gyud COVID,” Atty. Rennan Augustus Oliva, acting regional director NBI-CEVRO, said.

The complaints stemmed from NBI-7’s investigation about a patient at PSH whose identity due the NBI requested to withhold pursuant to a confidentiality agreement.

The patient, referred to as Patient X, died of non-COVID19 pneumonia and negative of coronavirus disease based on three tests conducted, including the RT-PCR test.

"Records obtained showed the despite the negative results for COVID-19 virus....Perpetual Succour Hospital staff without attaching test results thereto, intentionally sent a fraudulent claim for reimbursement to PhilHealth in the amount of Php335,519. 00 of (Patient X) hospital bills for Covid-19.

Severe pneumonia package under PhilHealth Circular No. 2020-0009," NBI said in its letter to Deputy Ombudsman for the Visayas Paul Elmer Clemente.

NBI said the "patient's illness falls only under ordinary common cases of pneumonia" which should have been paid under the Updated Medical Case Rate Package for Pneumonia- High Risk package in the amount of P32,000 only.

"The false, untruthful and fraudulent claim was approved in haste by PhilHealth personnel and officials without due diligence and thorough review being made of its supporting attachments," NBI-7 furthered.

Statement

PhilHealth-7 said it has yet to receive an official copy of the complaints, but added that it welcomes such investigation in the hope that “truth and justice would prevail.”

It said that from the start, it has been cooperative with the NBI-CEVRO’s investigation, providing copies of claim documents and allowing access to warehouse for the retrieval of all necessary documents.

 “It is unfortunate, however, that NBI-CEVRO has chosen to resort to a virtual trial by publicity, as this inevitably tarnishes the integrity and reputation of the Regional Office and its employees, and leads to further social media backlash that does not distinguish between guilty and innocent,” the statement read.

 PhilHealth-7 said its officers and employees in the regional offices also abide by the guidelines in processing claim documents per published circulars of the corporation and per interim guidelines of the Philippine Society for Microbiology and Infectious Diseases on the clinical management of patients with probable or confirmed COVID-19 infection, and by existing government accounting and auditing rules on releasing payments.

 “The entire PhilHealth Regional Office 7 workforce hopes that truth and justice would always prevail,” the statement read further.

As of this writing, there was no statement from the hospital regarding the complaints. — Caecent No-ot Magsumbol, JMD