Legal battle ensues
THAT DOES IT - Korina Sanchez (The Freeman) - June 12, 2019 - 12:00am

President Duterte has asked PhilHealth officials to resign after the revelation of the "ghost dialysis scam" where a dialysis center continued to file claims for a patient who had already expired. He is now considering appointing former military and police doctors in their place. This is no longer a surprise considering Duterte has appointed so many retired AFP or PNP generals to several government posts. The president’s confidence in Roy Ferrer notwithstanding, the current officers should be replaced due to the sheer amount that PhilHealth has allegedly lost to fraudulent claims. More than a billion pesos has allegedly been lost to fraud, something that PhilHealth officials deny. They claim only around P300 million has been lost to fraud. Is that a small amount?

Command responsibility is what the military calls it. Officials cannot say they do not know what is happening. They should know especially when a large amount of money is concerned. The officials should not have been preempted by the whistleblowers going to the media if an investigation is supposedly ongoing. If they informed the media ahead of the whistleblowers’ revelation, this might have been a different story. The "ghost dialysis" scam has supposedly been going on for years, so an investigation should have yielded results by now.

The co-owner of WellMed, already in NBI custody, is telling a different story. According to him, the whistleblowers were the perpetrators of the scam. But when PhilHealth issues checks, aren’t they made out to the hospital or center, and not to employees? If the whistleblowers are behind it, how do they benefit from it? Unless the owners and employees of the company have a prior arrangement when it comes to fraudulent claims. This is worth looking into. I still cannot believe how a scam like this would ever go unnoticed and why a center would even perpetrate it in the first place. Again, what were they thinking?

Whistleblowers and PhilHealth have filed a complaint against WellMed. The owners are also considering suing the whistleblowers. We have a huge legal battle in the offing. We can only hope that this exposé will strengthen PhilHealth procedures and processes against fraud, not only for dialysis sessions but for all diseases covered by PhilHealth's obligations as a state health insurer. For sure there have been fraudulent claims for other diseases or conditions such as cataracts, pneumonia, sepsis, and many more. PhilHealth should cease being the milking cow of unscrupulous medical practitioners and institutions. Only members should benefit and also be involved in strengthening PhilHealth’s processes. For one, they should inform PhilHealth once a member has passed away, to prevent further claims by a hospital or center. Free treatments should not be the only concern of members, but the overall health and viability of the insurer as well.

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