PhilHealth, dialysis center officials ‘conspired’ in anomalous fund release – NBI

INQUIRER FILE PHOTO / NINO JESUS ORBETA

MANILA, Philippines — Former Philippine Health Insurance Corp. (PhilHealth) president and CEO Ricardo Morales and other senior executives of the state health insurer had “conspired” with officials of a private dialysis center that received P33.8 million in emergency funds specifically earmarked for hospitals treating COVID-19 patients, according to the National Bureau of Investigation.

The NBI said Morales and his subordinates also ignored policies that they themselves set for the use of the P30-billion interim reimbursement mechanism (IRM) in providing “unwarranted benefits” to B. Braun Avitum Philippines Inc., a dialysis center.

Sen. Panfilo Lacson had identified B. Braun as a “favored” recipient of the special financial package from PhilHealth.

These findings prompted the NBI to bring an administrative and criminal complaint alleging corruption against Morales and more than 20 others in the Office of the Ombudsman.

‘Ghost, double claims’

The complaint was filed on Monday, a day before an interagency body headed by the Department of Justice (DOJ) endorsed also to the Ombudsman a report by the Presidential Anti-Crime Commission (PACC) alleging graft against 25 PhilHealth officials in connection with a “ghost” and “double claims” scheme that had financially strained the state insurer.

The complaint prepared by the NBI’s National Capital Region (NCR) office said a “conspiracy between PhilHealth officials and B. Braun Avitum was sufficiently established.”

It said PhilHealth “disregarded rules in approving and releasing IRM funds.”

Worse, the NBI said PhilHealth “erroneously” computed the amounts given to B. Braun and other hospitals that requested financial aid, which PhilHealth had intended as the government’s response to the pandemic.

The bureau cited PhilHealth Circular 2020-0007, which stated that the financial aid “must be based only on historical paid claims, which if properly computed, should only have been P23 billion,” not P30 billion.

It said B. Braun received benefit claims for dialysis procedures done even before the first coronavirus case was reported in the country and prior to the effectivity of the IRM on March 20, 2020.

Pending cases

The company, the NBI noted, had pending administrative cases with PhilHealth Arbitration Office for the filing of multiple claims, breaching warranties of accreditation, claiming for patients that were not admitted nor treated and unjustified admission beyond accredited bed capacity.

“Despite these red flags, PhilHealth approved the grant of IRM fund to B. Braun,” it said.

The NBI stressed that PhilHealth “failed to organize a validation team” which would have assessed the effects of the pandemic to properly determine the amounts to be taken from the IRM fund for health institutions.Besides Morales, the NBI recommended charges to be filed against PhilHealth executive vice president and COO Arnel de Jesus, senior vice presidents Renato Limsiaco and Israel Francis Pargas, Arturo Alcantara of PhilHeath Task Force Informatics and NCR area vice president Gregorio Rulloda.

Also included in the complaint were PhilHealth NCR officials Lailani Padua, Dr. Cynthia Camacho, Recto Panti, Maricar Barangtay, Victoria Gatuz, Dr. Imelda Trinidad de Vera, Lolita Tuliao, Gemma Sibucao and several other unidentified personnel.

The NBI said they should be held liable for graft, misappropriation of public funds, grave misconduct, gross negligence and conduct prejudicial to public interest.

B. Braun managing director Eduardo Rodriguez, finance director Arsenia Ladores and sales and marketing director Ricky Paglicawan were named private respondents.

Lack of documents

The NBI said the officials of the state insurer granted the dialysis center’s request for financial aid without validation and despite the lack of documents.

Worse, PhilHealth released amounts to B. Braun for “invalid/refiled claims,” according to the NBI.

“B. Braun was informed by officers of PhilHealth that dialysis centers are allowed to claim IRM fund,” the NBI said.

“Upon application of B. Braun, PhilHealth indicated the highest amount of IRM fund despite [the] failure of B. Braun to indicate in its letter of intent the percentage of IRM it will avail,” it pointed out.

The NBI said Therapy Management Services Philippines Inc., a wholly owned subsidiary of B. Braun, also got almost P16 million from the IRM allotment.

PACC findings

Assistant Justice Secretary Neal Vincent Bainto on Tuesday said Task Force PhilHealth concurred with the findings of the PACC, which looked into several schemes that had supposedly defrauded the state insurance agency of up to P154 billion since 2013. Those schemes were the subjects of a three-part investigative report by the Inquirer in June 2019.

“The [PACC] report also recommended charging PhilHealth officials and employees tasked to investigate such alleged fraudulent scheme and their consequent failure to properly prosecute those involved in the incident,” Bainto said in a separate statement.

He was referring to 27 fraudulent benefit claims totaling P1.17 million made by a certain Pamela del Rosario supposedly in connivance with some corrupt officials of PhilHealth’s Ilocos regional office based in Dagupan City, Pangasinan province.

Del Rosario allegedly used fictitious names to collect benefit claims from 2010 to 2014 for a supposed chemotherapy treatment for breast cancer, as well as those of her “parents,” who allegedly underwent treatment for cancer.

Investigators found that Del Rosario had falsified hospital records, receipts and other documents to collect the claims.

Bainto, however, declined at this time to identify the PhilHealth officials, most of whom were personnel of its Ilocos regional office. —WITH A REPORT FROM INQUIRER RESEARCH INQ