Duque warns treatment centers: Stop fraud or face consequences

Health Secretary Francisco Duque III. INQUIRER.net file photo / NOY MORCOSO

MANILA, Philippines — Department of Health (DOH) Sec. Francisco Duque III on Friday said medical centers should stop committing fraud by submitting fake dialysis claims to the Philippine Health Insurance Corp. (PhilHealth), as he vowed that these clinics would be held liable. 

“Kapagka nakitaan ka na mayroon kang pandarayang ginawa, yari ‘yung future payments mo, iaawas dun eh,” Duque said in an interview with Radyo Inquirer 990AM. 

“So ‘yung sistema meron namang safety net and safety provisions without prejudice of course to the filing of administrative and criminal cases, and revocation (of permit),” he added.

The Health chief also said PhilHealth is implementing stricter screening of claims through more detailed and evidence-based submissions in light of the controversy involving a private dialysis center in Novaliches, Quezon City, and its bogus dialysis claims to PhilHealth. 

“Patuloy po ang ginagawang reporma ng kasalukuyang administrasyon sa PhilHealth para matugunan itong mga pandarayang nagaganap sa panig ng mga health care providers at diumano may kasabwat sa PhilHealth,” the ex-officio chair of the state health insurance company said.

An investigative report of the Inquirer bared the alleged fraudulent scheme of WellMed Dialysis & Laboratory Center Corp. (WellMed). Edwin Roberto, a former employee of the center, said WellMed continued asking PhilHealth for dialysis payments even after their patients had already passed away. 

Roberto further said the clinic had filed and collected claims for dialysis treatment not only for dead persons but also for actual living patients who had not completed their treatments. The scheme, according to him, also involves claiming payments from PhilHealth under the dialysis package even when a different treatment had been performed. PhilHealth apparently continued to pay without checking the claims.

READ: PhilHealth pays for ghost kidney treatments | PhilHealth lost P154B to overpayments, fraud

PhilHealth has been investigating more than 8,900 similar anomalous cases, its spokesperson and vice president for corporate affairs Dr. Shirley Domingo said. PhilHealth also said it had filed 28 administrative complaints against WellMed since late last year.

Although PhilHealth suspended its payments to the center, the health insurance company admitted it has yet to revoke WellMed’s accreditation.

READ: 28 complaints filed vs dialysis center over bogus patients’ claims

WellMed, through law firm Gargantiel Ilagan & Atanante, vehemently denied the allegations.

“WellMed and its owners did not and would not, in any way, consent to, or participate in any ‘ghost dialysis’ or fraudulent scheme as described by Mr. Roberto,” the law firm said in a statement.

It also claimed WellMed’s former employees Roberto and Liezel Santos “connived with each other, took advantage of the trust reposed in them by WellMed’s owners, and perpetrated the fraudulent scheme, which they are now conveniently attributing to us.” 

Roberto is WellMed’s former assistant manager while Santos is the center’s former PhilHealth officer and cashier, according to the statement. (Editor: Jonathan P. Vicente)

READ: WellMed Dialysis Center denies claiming PhilHealth benefits for deceased clients