Gordon awaits PhilHealth report for possible probe
Sen. Richard Gordon has asked officers of Philippine Health Insurance Corp. (PhilHealth) for a report on the condition of the state-run company and the controversies they are facing ahead of a possible probe of irregularities when the 18th Congress opens next month.
Gordon is expected to retain his position as chair of the blue ribbon committee, which investigates wrongdoing by the government, state employees and government corporations.
“If there is an investigation that needs to be done, I will investigate,” he said.
Gordon said he recently met with PhilHealth officers, who explained to him the scheme involving WellMed Dialysis Center’s alleged payment of claims for bogus dialysis sessions for patients who had already died.
The scam could have been prevented if there was coordination with the Philippine Statistics Authority in the release of records of deceased patients, he said. The data should be computerized, he added.
If the scheme had been repeated multiple times, that could mean that PhilHealth insiders were involved and that they should be held accountable, Gordon said.
Mafia
He also noted allegations of a “mafia” inside PhilHealth, which he said he was inclined to believe.
“We had replaced PhilHealth [officers] several times. We do this almost every year. How can we learn?” he said. “If we would investigate this once and for all, we should dig into everything and find out if there really is a mafia.”
He said he told the PhilHealth officials to write down what they knew and submit their reports to him.
Aside from the alleged WellMed scheme, insiders said PhilHealth was also losing funds due to overpayment of benefit claims and the practice of “upcasing”—reporting more severe illnesses or more delicate treatments that would require higher payouts.
Inquirer reports
The WellMed scam unraveled other irregularities at PhilHealth, which were first reported by the Inquirer four weeks ago.
The three-part investigative report led to a shake-up in the state health insurer and forced the resignation of its president and CEO, Roy Ferrer, and other members of its board.
The two whistleblowers in WellMed’s “ghost dialysis” scam have been provisionally admitted into the government’s witness protection program.
Estafa cases
Despite giving away the scam and another scheme—continuing to collect PhilHealth payments for patients who had discontinued dialysis treatments—the former WellMed employees, Edwin Roberto and Liezel Aileen de Leon, were included in the estafa cases filed against WellMed owner Bryan Sy.
Sy, who is out on bail, has denied the charges.
Seven other WellMed executives, who have yet to be arrested, will also undergo preliminary investigation by the Department of Justice. They are Claro Sy, Therese Francesca Tan-Sy, John Ray Gonzales, Alvin Sy, Dick Ong, Porsha Natividad and Joemie Soriano.
Once fully admitted into the program, Roberto and De Leon will no longer be prosecuted and will serve as state witnesses.
