NBI sues Morales, other PhilHealth execs over irregular fund release

MANILA, Philippines — Ricardo Morales, former chief of the Philippine Health Insurance Corp. (PhilHealth), and several officials and employees of the state health insurer are facing graft raps over their alleged involvement in the anomalous release of funds intended for “fortuitous” events like the COVID-19 pandemic.

The National Bureau of Investigation (NBI) filed the complaint for alleged violation of the Anti-Graft and Corrupt Practices Act at the Office of the Ombudsman on Monday.

The NBI said the respondents allowed the release of P33.8 million under the interim reimbursement mechanism (IRM) funds to B. Braun Avitum Philippines Inc., a dialysis center that operates nationwide.

The IRM should only be used for fortuitous events like outbreaks or pandemics, which dialysis centers and other similar institutions do not address, according to the NBI.

Some of the other PhilHealth officials included in the complaint are incumbent executive vice presidents Arnel De Jesus and Renato Limsiaco.

Also included are three officials of Braun Avitum, which has constantly claimed integrity in its transactions.

The respondents also face raps for allegedly misappropriating funds in violation of the National Health Insurance Act of 2013, and the public officials involved will also face administrative charges of grave misconduct, gross negligence, and conduct prejudicial to public interest.

Following are the other respondents, from a list provided by the NBI:

PhilHealth

• Dr. Israel Francis Pargas, senior vice president, Health Finance Policy Sector
• Arturo Alcantara, Task Force Informatics
• Gregorio Rulloda, area vice president II and concurrent vice president, PhilHealth Regional Office-NCR
• Dr. Imelda Trinidad De Vera, head, Benefits Administration Section
• Lolita Tuliao, manager, PhilHealth Regional Office NCR – Central Branch
• Gemma Sibucao, fiscal examiner A, PhilHealth Regional Office NCR – Central Branch
• Lailani Padua, Fiscal Controller II, PhilHealth Regional Office NCR – Central Branch
• Dr. Cynthia Camacho, head, Benefits Administration Section, PhilHealth Regional Office NCR North Branch
• Recto Panti, manager, PhilHealth Regional Office NCR – North Branch
• Maricar Barangtay, fiscal examiner II, PhilHealth Regional Office NCR – North Branch
• Victoria Gatuz, social insurance officer II, PhilHealth Regional Office NCR – North Branch
• John/Jane Doe, medical evaluator, Philhealth Regional Office – NCR Central Branch and NCR North Branch
• John/Jane Doe, claims processing chief,  Philhealth Regional Office – NCR Central Branch and NCR North Branch
• John/Jane Doe, designated adjudicator, Philhealth Regional Office – NCR Central Branch and NCR North Branch

B. Braun Avitum

• Arsenia Ladores, finance director
• Eduardo Rodriguez, managing director
  Ricky Paglicawan, sales and marketing director

The NBI said that the IRM funds were released before the COVID-19 pandemic occurred, but they were used to cover hemodialysis procedures, which are not considered fortuitous.

The NBI also underscored that PhilHealth granted the IRM fund release to Braun Avitum despite its sketchy track record — like the filing of claims for patients not admitted or treated in the hospital.

“Track record of the aforesaid dialysis center revealed that numerous administrative cases for filing of Multiple Claims, Breach of Warranties of Accreditation, claims for non-admitted/non-treated patients and unjustified admission […] Despite these red-flags, PhilHealth approved the grant of IRM fund to B. Braun Avitum,” the NBI explained.

“It is also worth stressing that PhilHealth failed to organize a Validation Team as required by PC 2020-0007, which is necessary to assess the effects of COVID 19 pandemic and properly determine the percentage of allowable IRM fund to be granted to the requesting HCI,” it added.

The issue about the irregular release of IRM funds was opened during a Senate hearing last August 2020, after allegations of massive corruption within PhilHealth broke out and prompted the resignation of some officials.

During the hearings, it was revealed that P45 million of the IRM was allocated to Braun Avitum.

Sen. Panfilo Lacson called for a separate probe on the issue, admonishing the Department of Health and Secretary Francisco Duque several times for allowing such schemes to take place.

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