MANILA, Philippines — Alarmed by the huge losses by the Philippine Health Insurance Corp. (PhilHealth) due to fraudulent claims, President Rodrigo Duterte ordered early on Saturday the arrest of the owners of a private dialysis clinic in Quezon City at the center of an alleged scam and indicated he would overhaul the state health insurance company to make it more accountable.
Speaking on the television program of Kingdom of Jesus Christ leader Pastor Apollo Quiboloy, the President expressed his displeasure over the P154 billion lost by PhilHealth that was based on the Inquirer’s three-part report on the fraud scheme.
“The sheer amount of 100 something billion [pesos] is totally, totally unacceptable to me,” the President said as he noted that many ailing Filipinos depended on PhilHealth.
“What was worse is it’s public money,” he said, adding that he was “very much interested to find out what happened to the money.”
‘Change maybe all of you’
Addressing PhilHealth officials, he said: “But for the sheer amount that was lost, I have to reorganize your entity, change maybe all of you and install… systems of accounting and accountability.”
The President zeroed in on WellMed Dialysis Center, which was exposed by two whistleblowers — both former employees of the clinic — for claiming benefits for “ghost” treatments of dead or nonexisting patients.
WellMed’s lawyers said their client “vehemently denies” the allegations originally made by two of its former employees who blew the whistle on the alleged scam first reported by the Inquirer last week.
“I’ll tell the NBI (National Bureau of Investigation): Arrest the idiot. And I will bring him to Malacañang and I’ll ask him: Tell me the truth or I’ll throw you to the [Pasig] River. But he will be extricated. We’ll not allow him to drown,” he said.
Later in the program, the President said the NBI “should take over by tomorrow (Sunday) and start to summon everybody.”
In addition to Bryan Christopher Sy named in the Inquirer report, Securities and Exchange Commission documents in 2015 showed there were four other stockholders — Claro Ngo Sy, chair and president; Alvin Wang Sy, corporate treasurer; Therese Francesca Rodrigo-Tan, in charge of purchasing; and Dick Sy Ong, in charge of administration.
Continuing crime
A former prosecutor, the President said WellMed was involved in syndicated estafa, a continuing crime that is nonbailable.
“So you arrest them because right at this moment, the estafa, the malversation of money is continuing,” he said.
He lamented how the amount of funds lost by PhilHealth had ballooned “without the necessary checks.”
Still, the President said he “[did] not have the slightest doubt about the integrity and honesty” of Roy Ferrer, the acting president and CEO of PhilHealth.
Justice Secretary Menardo Guevarra said in a statement that he had instructed the NBI “to get involved in the investigation as soon as possible.”
Undersecretary Mark Perete, Department of Justice spokesperson, said in a separate statement the President’s directive was “consistent with his anticorruption effort.”
“The ghost dialysis scam shows how corruption affects the most vulnerable among us by depriving them of their most basic needs,” Perete said.
Still paying
Data from PhilHealth’s internal monitoring system called “dashboard” showed that it was still paying WellMed until this month, contrary to a statement by its legal sector chief, Rodolfo del Rosario, that it had stopped doing so since February as part of efforts to “exhaust all administrative remedies” against the clinic for its alleged fraudulent claims.
Based on the record provided by an insider to the Inquirer and culled from PhilHealth’s dashboard, the state insurer paid the Quezon City-based dialysis center more than P4.2 million for 255 dialysis claims, including 184 for treatments done from February to June, amounting to close to P3.2 million.
The PhilHealth dashboard showed it had processed and paid for 19 claims made by WellMed totaling P273,000 in February.
The PhilHealth insider who provided the data noted that the belated payments to WellMed were “normal” since there were instances when hospitals or clinics submitted incomplete documents or attachments.
“Probably these [cases] were endorsed [to the] legal [sector] for verification on some concerns,” said the source, who requested anonymity for lack of authority to speak and release information to the media.
Operations ongoing
A written WellMed announcement posted inside its clinic in Novaliches, Quezon City, seen by the Inquirer on May 30, showed it was still operating as late as last month. The notice directed its “employed patients” and “individually paying members” to submit their PhilHealth proof of payment or certificate of contribution in order to claim their PhilHealth benefits.
In a separate announcement dated April 29, WellMed told its patients who had undergone 45 hemodialysis sessions, including hospital admissions, to get their “certificate of available days of hemodialysis” from the Local Health Insurance Office in Fairview, Quezon City.
A family member of one WellMed patient confirmed to the Inquirer on Friday that his father had just had his dialysis earlier that day that was paid for by PhilHealth.
He said he feared what could happen to the dialysis center’s patients once PhilHealth finally halted its operations.
“Just one dialysis session missed could already be life-threatening to a patient,” he said.
“We will stay with WellMed for as long as it remains open. We will be forced to transfer [to another clinic] if it closes down, but that would cause a lot of inconvenience to their patients,” he said, adding that his family could not afford dialysis without PhilHealth funding. —With reports from Jerome Aning, Jovic Yee and Mariejo S. Ramos