PhilHealth execs face raps for dialysis scam

MANILA, Philippines — Philippine Health Insurance Corp. may have squandered P1.8 million of its funds this year after it allowed the processing of claims by a private dialysis center under investigation for fraud allegations.

The National Bureau of Investigation (NBI) said a group of lawyers and doctors comprising PhilHealth’s accreditation committee may face graft charges before the Department of Justice for allowing WellMed Dialysis Center to continue processing payments despite the discovery of ghost dialysis claims by a fact finding group.

Anti-graft investigators said Dr. Lolita Tuliao, branch manager of the PhilHealth Regional Office-NCR, did not issue a suspension order on WellMed despite learning of the fraudulent claims as early as January this year.

“It was on Jan. 24, 2019 when the PRO-NCR learned of the fraudulent claims. However, instead of securing the funds of PhilHealth, Tuliao did not issue a suspension order and processed the claims of WellMed,” the complaint read.

Tuliao and 20 other officials have also been charged for violating the National Health Insurance Act for misappropriation of funds, and for violating the Code of Conduct and Ethical Standards for Public Officials and Employees.

Also named in the complaint were accreditation department head Dr. Rizza Herrera, accreditation subcommittee chairpersons Dr. Bernadette Lico and Dr. Janice Perlas and members, branch managers Dr. Leilani Asprer, Rofien Ison, Dr. Manuel Lampitoc, Recto Panti, Henry Almanon, Dr. Jeffrey Pe, Cheryl Welan, Dr. Quintin Callueng, Mary Grace delos Santos, Maricel Maglalang, Susan Romero, Yvonne Fernandez, Dr. Katrina Aguilar, Dr. Cynthia Camacho, Dr. Imelda Pe, Dr. Arsenio Alcantara and Dr. Leticia Aguda.

NBI anti-graft division head Catherine Camposano-Remigio said the NBI’s probe on the issue was an “offshoot” of the testimonies of former WellMed employees Liezel Aileen de Leon and Edwin Roberto, who blew the lid on the alleged ghost claims.

Before they exposed the scam to the media, the whistleblowers reported the clinic’s benefit claims for dead individuals to PhilHealth as early as 2018, prompting an internal investigation and recommendation to suspend WellMed’s accreditation and claims.

Agent on case Ferdinand Razon said that because of the undue benefit granted by accreditors, WellMed was able to process P1.8 million worth of claims from January to May this year.

“The transgressions of some established and definite rules of action by the subjects resulted in the unlawful disbursements… paid to WellMed, despite the allegations of fraudulent claims as early as 2018,” the complaint read.

“The accreditation extended to WellMed despite the lacking document, the failure of the (PhilHealth Regional Office-NCR) to establish its integrity, and the payment of claims gave unwarranted benefits to WellMed,” it added.

NBI deputy director for investigative services Vicente de Guzman III said the agency will dig deeper to determine if there is inside job.

“We can’t categorically say (it’s an inside job). That’s why the investigation is ongoing to establish the linkages between these health care providers and some officers of PhilHealth,” De Guzman said.

He said the NBI has ordered its regional offices to look into other health care institutions within their jurisdiction for possible ghost claims.