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PhilHealth to hire docs, lawyers to probe ‘ghost’ dialysis scandal

There are ghosts roaming around hospitals and medical centers, and they’re undergoing medical procedures at Philippine Health Insurance Corp.’s expense.

To counter this, the government health insurance firm said it will hire 130  fraud investigators to put a stop to the “ghost” dialysis scandal that is rocking the beleaguered government health agency.

To aid the investigation, PhilHealth is also set to hire 12 more lawyers, and 54 doctors to validate the alleged fraudulent claims, including claim made by a dialysis center in Quezon City.

The dialysis center allegedly filed “ghost” claims to PhilHealth.

PhilHealth, in turn, made payments for dialysis treatments to health providers without knowing that some of the patients have long been dead.

The racket was revealed by Edwin Roberto, a former employee of the dialysis center.

According to lawyer Harry Roque, who is representing Roberto, told reporters anomalies hounding PhilHealth are not new.

“Here in the Philippines, the dead are not just voters, they can also undergo dialysis,” he said.

“Anomalies in PhilHealth are not new. During the 16th Congress, there are poor people with pneumonia, and cataract that are being used to make claims at PhilHealth.”

Meanwhile, Akbayan Senator Risa Hontiveros on Thursday called for an urgent and comprehensive investigation on the funds being used and released by PhilHealth after following that PhilHealth funds may have been misused to pay for the dialysis treatments of non-existent patients.

Hontiveros, vice chairman of the Senate Committee on Health and Demography, issued the statement following claims by whistleblower Roberto who said that PhilHealth has been approving questionable claims and releasing payments for ghost dialysis, or dialysis treatments which were never done, to the benefit of fraudulent clinics.

She noted that the gravity of the recent allegations should prompt government to check if every peso under the PhilHealth is indeed being used in a manner compliant with laws and the PhilHealth's mandate.

“We cannot allow fraud and greed to impede the effective delivery of health services to the people,” she said.

Hontiveros, a former board member of Philhealth from 2014 to 2015, said that if the allegations are true, then the ghost dialysis scheme not only defrauds funds from government, but also deprives countless Filipinos of the chance to avail of free treatments which may improve their health, if not save their lives.

She said that according to Roberto, the scheme works by filing and collecting claims for dialysis treatment not only of dead persons but also of actual living patients who have not completed their treatments.

The scheme also involves claiming payments from PhilHealth under the dialysis package even when other treatments were actually performed.

“This scheme not only steals funds from government, but may have also led to the deaths of people who would have otherwise benefited from PhilHealth’s programs. A response from government is needed,” she said.

She added that the cases of fraud and abuse of the government’s health insurance system must be fixed before the implementation of the Universal Healthcare Act, which will provide all Filipinos membership in a universal health insurance program which they can use to avail of health services.

“The funds under our national health insurance program are supposed to empower our people especially the poor and bring them closer to affordable and effective healthcare. Any misuse of these funds is a betrayal of this vital mission, and must be stopped” Hontiveros said.

PhilHealth acting president and CEO Dr. Roy Ferrer said they have filed an administrative complaint against WellMed Dialysis & Laboratory Center Corp. in Novaliches City to prove that they do not condone such practices.

“The corporation does not condone such acts as it undermines the people’s entitlement to one of their basic rights as human beings—the right for appropriate medical care,” said Ferrer.

“In relation to this case, the corporation has filed 28 counts of administrative claims for non-admitted treated patients, misrepresentations by furnishing false or incorrect information, and breach of warranties of accreditations performance against the mentioned dialysis center,” he added.

Ferrer, who said that PhilHealth is financially stable and their operation is stable, said 12 other cases are also being evaluated for filing.

The PhilHealth official also encouraged other Roberto to come out, ensuring that they will be protected once they choose to do so.

“We encourage whistleblowers to come out in the open and my view, even modern corporation with modern technology. It’s really difficult sometimes to detect fraud so that’s why we are encouraging the public and the people to report to us any fraudulent activities that you observe with the claim processing of PhilHealth. If you think it’s fraud, report it,” Ferrer said.

Ferrer added that his office is also intensifying efforts to cleanse their ranks, adding that several middle managers have already been suspended for various violations.

Topics: Philippine Health Insurance Corp. , Harry Roque , Risa Hontiveros
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