Senate probe bares numerous pending cases involving eye clinics

MANILA, Philippines - Senate Blue Ribbon committee chairman Teofisto Guingona III reprimanded yesterday the appeals body of the Philippine Health Insurance Corp. (PhilHealth) for sitting on over 80 cases involving alleged offenses committed by eye centers, clinics and other facilities for four to six years.

At the resumption of the committee hearing on the allegedly spurious claims made by some clinics and medical facilities from PhilHealth, Guingona aired his concern about the volume of unresolved cases, some of which were filed before 2010.

These cases came even before reports of alleged illegal and unethical practices of some eye centers in Metro Manila surfaced, which eventually led to the suspension of payment of claims to two facilities – the Pacific Eye Institute in Makati and the Quezon City Eye Center.

Guingona said he received the report on the pending PhilHealth cases the other day, after several weeks of prodding the state health insurance firm to produce them.

Citing the report, Guingona said there were 82 cases pending resolution by the Committee on Appealed Administrative Cases (CAAC) against health care providers and members, now headed by former Akbayan party-list representative Risa Hontiveros.

Guingona noted that some concerned medical facilities with more than two offenses had been identified but no action has yet been taken.

He pointed out that the CAAC had even recommended the imposition of penalties against all 82 concerned facilities.

Alexander Ayco, member of the CAAC, said that when he joined the body in 2011, it was handling cases dating as far back as 2001 and 2003.

Ayco said the CAAC did not have any guidelines to follow nor legal personnel to help them in handling the cases. He said, however, that some actions have been taken to address the problem.

Health Secretary Janette Garin, who was present in the hearings for the first time yesterday, admitted there was no excuse for the delays.

“We will look into the legal repercussions, into the IRRs (implementing rules and regulations) that are existing, cut all these bureaucracy and possibly instill a stop payment order pending investigation,” Garin said, as she offered to come up with concrete actions within a month.

She said most reports have not reached the office of PhilHealth president and chief executive officer Alexander Padilla.

Speaking with reporters after the hearing, Padilla likened the situation with that of the Supreme Court, which he said takes years to issue resolutions.

Raymond Evangelista, owner of the Quezon City Eye Center, appealed for the resolution of the case against them because of its serious impact on business.

Evangelista said dragging the case for several years, with a stop payment in place, would lead to the closing of the center even if it would eventually be found innocent.

He argued that PhilHealth officials presented inaccurate data, which had been bloated by millions.

“This matter has not been clarified and I don’t see any proper investigation of any kind with regard to this,” he said.

He said PhilHealth claimed that his eye center made a total of P156 million in reimbursements in 2014. But he said the center received only a total of P110 million from the agency, which included professional fees for doctors.

The basis of investigation, he said, is also questionable since the top 10 list released by PhilHealth was limited only to eye centers and excluded cataract operations performed by various hospitals.

“I’m sure the list will be different if the PhilHealth corrects its figures and includes the reimbursements of hospitals,” he said.

PhilHealth earlier said that a review of the claims made for cataract surgeries showed that nine out of 10 of the biggest recipients were eye centers based in Metro Manila.