78 hospitals, 18 docs face raps ––Philhealth

Rodrigo Duterte

Linked to fraud claims; ‘ghost dialysis’ scam angers Duterte.

THE Philippine Health Insurance Corporation or PhilHealth yesterday said 78 hospitals are currently facing cases over fraud claims.

Meanwhile another scandal involving “ghost dialysis” that has rocked PhilHealth has prompted President Rodrigo Duterte to order the agency to file criminal complaints against its officials involved in the scam.

PhilHealth management was directed “to institute criminal actions against those officials and employees who wittingly or unwittingly allowed such misuse of funds to take place for years,” Presidential Spokesperson Salvador Panelo said yesterday.

The alleged “ghost dialysis” scam was reportedly revealed by a former employee of a dialysis center in Quezon City. The scheme was allegedly used to make fraudulent claims to the government health insurance firm.

PhilHealth senior manager Rey Balena said the 78 hospitals in hot water are believed to have been involved in 370 fraud cases.

“Ito ho yung nasa arbitration na po. Dito sa non-cataract cases sa kasalukuyan meron pong 78 hospitals na kasalukuyang may kaso involving 370 cases. For the cataract cases sa ngayon meron tayong tatlong hospitals involving 2,000 cases. Siguro napakaraming may katarata kaya ginawan nila ito ng scheme,” he said, adding cases have already been filed against 18 doctors.

The government-owned and controlled corporation which administers the National Health Insurance Program earlier revealed that it suspended 38 erring officials and employees in the fight against fraudulent and corrupt activities.

It said those suspended were mid-level managers allegedly involved in processing fraudulent transactions.

Two former employees of WellMed Dialysis & Laboratory Center Corp. had claimed that the PhilHealth-accredited facility has been processing and benefiting from claims of deceased patients.

PhilHealth confirmed that they were able to monitor fraudulent acts involving WellMed. Their findings showed that 28 of the medical cases that have been filed involved dead patients while 12 others are under investigation.

“Twenty-eight counts of admin cases na ang naisampa sa prosecution department namin. Meron tayong quasi-judicial powers para litisin o dinggin ang ganitong kaso,” Balena.

WellMed has denied involvement in fraudulent activities.