Ex-PhilHealth exec: PhilHealth’s NCR officers are liable for ‘ghost’ dialysis scam
MANILA, Philippines — Regional officers of the National Capital Region (NCR) office of the Philippine Health Insurance Corp. (PhilHealth) should also be held liable for the alleged ‘ghost’ dialysis treatment scam, a former official of the agency said Thursday.
According to former PhilHealth Independent Director Dr. Anthony Leachon, PhilHealth regional officers are in charge of ensuring that hospitals and treatment facilities — like Wellmed Dialysis Center in Quezon City — are abiding with PhilHealth’s standards.
“I think so, kasi command responsibility ‘yon na naka-takas ‘yon,” Leachon told ABS-CBN News Channel when asked whether NCR officers should also be reprimanded in the wake of the scam.
“The command responsibility starts at the highest levels, but sa dami ng ginagawa ng presidente at saka ng board all of these resolutions, dapat ‘yong checklist na ‘yon nandoon,” he added.
Leachon explained that had officers checked Wellmed’s transactions, electronic records would have shown Wellmed’s non-compliance with several PhilHealth requirements.
Wellmed is being accused of collecting claims from PhilHealth for the dialysis treatments of already deceased patients.
“Ang unang-unang magsasabi n’yan is of course ay ‘yong nandoon sa ground, regional president, alam nila, the directors there kung sino dyan ang red-flagged items. Sila mag-eevaluate eh, sila ang may checklist eh, mayroong guidelines eh,” he said.
“Para sa electronic records lalabas ‘yon na hindi masasagutan ‘yon kasi the computer will tell you, you cannot advance to the next step because this particular requirement is not fulfilled,” he added.
President Rodrigo Duterte had recently asked PhilHealth’s high-ranking officials, including acting chief Roy Ferrer, to submit their courtesy resignations following the controversy.
READ: PhilHealth execs asked to submit courtesy resignation over dialysis mess
The alleged scam was uncovered when a former Wellmed employee revealed in a Philippine Daily Inquirer story the existence of ‘ghost dialysis’ treatments where deceased patients are made to appear alive and were able to collect benefits from PhilHealth by providing the agency with documents with forged signatures. Wellmed has denied accusations linking it to the scam.
READ: PhilHealth pays for ghost kidney treatments
READ: WellMed Dialysis Center denies claiming PhilHealth benefits for deceased clients
Leachon also noted that for PhilHealth to fully implement the Universal Health Care Law, it has to seek assistance from private auditing firms — which may be tapped by Health Secretary Francisco Duque to address fraud issues.
According to Leachon, hiring a private auditing firm such as SGV, will provide PhilHealth with an additional vantage point aside from the audit provided by the Commission on Audit (COA).
“You need a third eye, to see from a different vantage point. You need somebody na independent, na pupunta doon. Ang problema with the COA audit kasi tapos na eh, so you need right now a clean house,” Leachon said.
“So dapat ang SGV nandyan na iga-guide nila ‘yong audit system,” he added. (Editor: Mike U. Frialde)
