Cases filed vs dialysis center for ‘ghost’ kidney treatments, says PhilHealth

MANILA, Philippines — The Philippine Health Insurance Corp. said it has already filed administrative cases against a dialysis facility in Quezon City that allegedly made benefit claims for non-existent kidney treatments.

In a press briefing Thursday, PhilHealth said it filed administrative cases against WellMed Dialysis and Laboratory Center in Novaliches, Quezon City last November for misrepresentation and falsification. At least four doctors also face complaints for possible involvement in the scheme.

“This is the truth of it that we acted upon this case and not sitting on it,” Roy Ferrer, acting president and CEO of PhilHealth, said.

According to a Philippine Daily Inquirer report, PhilHealth continued paying for the dialysis treatments of a patient who had died in 2016. Edwin Roberto, a former employee of WellMed, said the dialysis center continued filing claims for the patient’s sessions despite her death.

PhilHealth said there is a move to withdraw the accreditation of the center. It added that payment for all claims filed by the dialysis facility had been suspended as early as February.

“PhilHealth’s compassion is not reciprocated by some of its partners, instead some choosing to milk the national health insurance program of millions in funds,” Ferrer said.

He added: “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 to appropriate medical care.”

Call to whistleblowers

Ferrer lauded the whistleblowers for baring the alleged frauf by the dialysis center and encouraged more people to come out in the open if they know about other anomalies.

“Do not be afraid. We are there to protect you,” the PhilHealth president said.

Ferrer added there are intensified efforts to cleanse the corporation's ranks, with several middle managers suspended for various violations. 

But in an interview on CNN Philippines, Harry Roque, the lawyer of the complainants who revealed alleged anomalies in PhilHealth, said the whistleblowers will file cases against officials of the government-owned and -controlled corporation.

The Inquirer report said that Roberto and his fellow former employee Liezel Santos told PhilHealth about the scheme last year but were told in January that their complaint against the dialysis center remained pending. — Gaea Katreena Cabico