CEBU, Philippines — A Cebu City-based healthcare facility has came to the defense of its employees who were allegedly involved in the fraudulent reimbursement of Philhealth claim.
The Perpetual Succour Hospital Inc.(PSHI), in a statement, belied the allegations hurled against its four employees—Brenda Mondares, finance manager; Gladys Sarmiento, assistant department manager; and billing officers Jaye Anne Carcuevas Arañas and Gina Misagal.
Jose Ray Bael, the legal counsel of PSHI, said there were no irregularities in processing the claims of a patient, referred to as Patient X.”
“PSHI is strongly confident that the PhilHealth claim for Patient X is above board as it was based on medical diagnosis of competent and respected medical professionals,” part of the statement read.
“The claim was supported by medical records submitted to PhilHealth and passed scrutiny and applicable criteria set by PhilHealth circulars and guidelines,” it added.
PSHI has yet to receive a copy of the complaint filed by National Bureau of Investigation in Central Visayas (NBI-7) before the Ombudsman for the Visayas last Thursday.
But Bael said PSHI is ready to respond to corruption allegations.
“A detailed factual and legal counter-statement will be issued and filed with the Office of the Ombudsman proving their innocence and total absence of fraud or malice in the preparation and submission of the PhilHealth claim for Patient X.”
“It is unfortunate, however, that NBI-7 intended a public announcement of the filing of cases against four PSHI officers and personnel for alleged fraudulent PhilHealth claim before they are furnished a copy of the alleged complaint and given the opportunity to answer the accusations,” the statement further read.
Complaint
NBI-7 filed criminal and administrative complaints against
12 officials and employees of Philippine Health Insurance Corporation in Central Visayas (PhilHealth-7) and four PSHI workers before the anti-graft body.
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 Mmisconduct.
Lawyer Wenceslao Galendez of NBI-7 said PhilHealth and PSHI made a fraudulent act when
a reimbursement of P333,519 was made in the bill of “Patient X.”
The patient reportedly died due to acute respiratory failure secondary to community acquired pneumonia, inthrahepatic cholangiocarcinoma Stage 4 with hepatic carcinomatosis and COVID-19 probable last May 16 at the said hospital.
Galendez said “Patient X” should have not been declared a COVID-19 probable because he was tested negative thrice—twice through rapid tests and once using real-time reverse transcription-polymerase chain reaction (rRT-PCR).
Under the Interim Reimbursement Program (Philhealth Circular No. 2020-0007), COVID-19 claims may be made if the cases fall under “COVID-19 probable” and “COVID-19 confirm.” The IRM is a mechanism under the National Health Insurance Program that grants financial aid to healthcare providers affected by calamities.
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 said.
PhilHealth-7, in an earlier statement, said it welcomes such investigation in the hope that “truth and justice would prevail.”
PhilHealth is also yet to receive an official copy of the complaints. — KQD (FREEMAN)