Bacolod hospital fined over fraudulent PhilHealth claims
By Nestor P. Burgos Jr.
Visayas Bureau
First Posted 18:07:00 09/25/2008
Filed Under: Crime, Hospitals and Clinics, Health insurance
ILOILO CITY, Philippines—The Philippine Health Insurance Corp. (PhilHealth) has found a Bacolod City hospital guilty of fabricating claims for cataract surgeries conducted on patients recruited through medical missions.
In a 14-page decision dated September 16, the PhilHealth arbitration department found the Bacolod Our Lady of Mercy Specialty Hospital guilty of six counts of “padding of claims” and “breach of accreditation.”
PhilHealth ordered the hospital to pay a fine of P10,000 for each count or a total of P120,000. It also meted a three-month suspension of the hospital's PhilHealth accreditation for each count or a total of 36 months.
The Philhealth also stated that it would not pay the six claims found to have been padded and directed the hospital to refund the fraudulent claims that have been paid.
In a statement released by the office of the hospital’s chief executive officer, Dr. Evangeline Johnson, the hospital said it would file a motion for reconsideration.
“Bacolod Our Lady of Mercy Specialty Hospital and its staff, nurses and doctors reserve their rights to seek due process in the proper legal forum, to bring out the truth and obtain justice,” the hospital said in its public statement.
It said the hospital has been “subjected to false and baseless accusations” but would continue to receive and admit patients both members and non-members of PhilHealth.
Lawyer Jay Villegas, manager of PhilHealth’s fact-finding and administrative investigation department, said in a telephone interview that the hospital would have until October 1 to appeal the ruling or it would become final and executory.
The case stemmed from a complaint filed by the PhilHealth's prosecution department on January 7 concerning the PhilHealth claims of six patients who underwent cataract surgery.
The hospital filed claims for oxygen and intravenous fluids reportedly used during the surgeries on the patients.
But the patients, in their statements submitted to PhilHealth, stated that there was no oxygen or intravenous fluids administered to them during the confinement.
The hospital sought for the dismissal of the complaints and questioned the authority of PhilHealth officials and employees who did the investigation to administer oaths to documents related to case.
It claimed that the complaint was “based on hearsay” and on “pre-fabricated statements.”
It presented affidavits of attending physicians and nurses, and of three patients recanting earlier statements given to the PhilHealth investigating team.
In its decision, the arbitration department affirmed its authority to investigate and prosecute the complaint as well as the authority of PhilHealth personnel to administer oaths to the patients' affidavits.
PhilHealth gave credence to the statements of the patients given to investigators rather than the affidavits submitted by the hospital.
It said the sworn statements of the patients given to investigators were “clear and unambiguous in their declaration that oxygen and IV fluids were not given to them.”
Philhealth noted that the sworn affidavits of the three patients submitted by the hospital were undated and not notarized. It also observed as suspicious that the statements were “identical in all details” including the words used and every detail.
It cited Supreme Court jurisprudence that “affidavits of recantation could easily be secured through monetary consideration or through intimidation.”
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