The Philippines National Bureau of Investigations (NBI) has launched a wide ranging inquiry into medical clinics and health service providers associated with Philippine Health Insurance Corporation (PhilHealth).
The announcement came during a media briefing in Manila earlier today (June 13) during which three former employees of Quezon City-based WellMed Dialysis & Laboratory Center Corporation (WellMed) were presented following explosive accusations last week by the Philippine Daily Inquirer (Inquirer) of systematic corruption.
During the media briefing NBI deputy director for investigative services, Vincent A. De Guzman III, revealed that the NBI was investigating a wide range of businesses which bill PhilHealth for services. “We are also not singling out WellMed, we are also investigating the claims of other medical entities”, he said.
Last week the Inquirer published claims by former employees of Wellmed, a kidney treatment centre in Novaliches, Quezon City, alleging the company had forged the signatures of dead patients to make fraudulent claims against PhilHealth since 2016.
One of the whistleblowers, Edwin Roberto, alleged that PhilHealth continued to approve and release payments for a PhilHealth member, ‘Maria’, even after her death in March, 2016.
It was additionally claimed that WellMed had billed for patients who had yet to complete their treatment, robbing them of their medical benefits.
Mr Roberto was presented at today’s media briefing, along with fellow whistle-blower Liezel Aileen S. de Leon, and WellMed co-owner and vice president, Dr Bryan Christopher Sy.
PhilHealth executives next
The three have been charged with estafa (fraud), and falsification of documents, in what Mr De Guzman III described as an ongoing crime. WellMed was still submitting fraudulent claims up to June 7, the briefing heard.
Mr De Guzman III said that the next phase of the investigation by the NBI is allegations levelled at PhilHealth executives.
Yesterday, former health secretary Janette Garin, revealed that some doctors and officials of PhilHealth were/ are receiving up to PHP32,000 (about US$617) from the state insurance firm for each “ghost” treatment. PhilHealth were also paying for pneumonia and dengue treatments for bogus patients, she said.
The Inquirer’s report alleged that if PhilHealth’s payments for pneumonia from 2010 to 2018 are to be believed the infection has reached “epidemic proportions” in the Philippines, yet no outbreak has been declared by the Department of Health (DOH).
All PhilHealth providers “being watched”
Reinforcing the wide-ranging nature of the NBI’s investigation, Ferdinand M Lavin, deputy director for Forensic Investigation Service, said practically any entity claiming reimbursement for medical services from PhilHealth is “being watched by the NBI and PhilHealth jointly”.
Last week as the scandal snow-balled, acting PhilHealth CEO, Roy Ferrer said the NBI and other authorities had launched a probe into “economic saboteurs”, but denied claims over-payments of PHP154 billion ($2.95 bln) over the past six years, describing excess payments as payments for “efficiency gains”.
PhilHealth had, Mr Ferrer admitted, filed 28 administrative cases against WellMed for misrepresentation and falsification of claims, with another 12 cases of fraudulent claims pending investigation.
While publicly backing Mr Ferrer and saying he did not have the “slightest doubt about his honesty”, on Monday President Rodrigo Duterte asked him and the PhilHealth board to resign. They did.
Universal health care
The scandal comes barely four months after President Duterte signed into law the Universal Health Care (UHC) Act (Republic Act No. 11223), automatically enrolling all Filipino citizens in the National Health Insurance Program (NHIP).
Following the Inquirier’s initial story a string of accusations over ghost treatments, over-charging, and charging for services not provided have been made.
While some have guestimated the level of fraud between 2013 and 2018 to be as high as PHP154 billion ($2.9 bln), earlier in the week Philippine Health Secretary Francisco Duque III hosed down speculation that the losses were so great.
At an “average value claim” of PHP10,000 (and excluding so-called efficiency payments), Mr Duque said the potential loss was more like PHP232 million ($4.5 mln), or about one per cent of the PHP433-billion ($8.3 bln) in total benefits paid over the same period.
According to a report by the Philippine Star, PhilHealth had paid a total of PHP47.2 billion ($906 mln) in claims up until the end of last month, compared to PHP38.4 billion ($737 mln) during the same period in 2018.
The media briefing today heard that arrest warrants had been issued for a further seven people associated with WellMed, including company physicians Porshia Natividad and Joemie Soriano, who are accused of signing the fraudulent claims.
Feature video CNN Philippines
- PhilHealth lost P154B to overpayments, fraud (Philippine Daily Inquirer)
- Duterte asks PhilHealth acting president, board members to resign (Rappler)
- NBI starts probe into alleged ‘ghost dialysis’ scam (GMA News)
- NBI arrests WellMed owner over ghost dialysis issue (Philippine Daily Inquirer)
Between November 2010 and February 2012 she was a staff writer at Daylight Online, Nigeria writing on health, fashion, and relationships. From 2010 – 2017 she worked as a freelance screen writer for ‘Nollywood’, Nigeria.
She joined AEC News Today in December 2016.