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PhilHealth, hospital execs sued over COVID claims

NBI in Central Visayas files graft charges vs 11 people after claimant made to appear as front-liner stricken with coronavirus

CEBU CITY—The National Bureau of Investigation has filed graft complaints against eight officials of Philippine Health Insurance Corp. (PhilHealth) and three officers of a private hospital in this city for approving an allegedly fraudulent claim for a patient who was not sick of COVID-19.Rennan Augustus Oliva, the NBI director for Central Visayas, on Monday asked the Office of the Ombudsman to hold officials of PhilHealth and Chong Hua Hospital liable for violating the Anti-Graft and Corrupt Practices Act, and for malversation of public funds through falsification of documents.

Oliva said a 41-year-old patient was made to appear as a front-liner who tested positive for COVID-19 and claimed a full benefit from PhilHealth. But the person was neither a front-liner nor positive for COVID-19, the NBI later learned.

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Verification

“We verified this through certifications from the Social Security System, Bureau of Internal Revenue, and the local government unit of Carmen, Cebu, where the person resided,” Oliva said at a press conference on Tuesday.

“Even his barangay certified that he was not a front-liner. In fact, he was jobless for many years,” he said. Arnel Pura, the NBI regional executive officer and supervising agent, said the man was taken to Chong Hua Hospital on March 30, 2020, after he complained of shortness of breath. He had liver and kidney ailments and had undergone medical treatments, Pura said.

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Since his bills were piling up, the patient, whose identity was withheld by the NBI, was transferred to Vicente Sotto Memorial Medical Center the next day.

Forged documents

Pura said the NBI found that Chong Hua filed for a COVID-19 claim of P193,000 in PhilHealth from the patient, who eventually died of kidney failure on April 10.He said the patient was not even qualified to receive reimbursements from PhilHealth since he was not an active health-care worker, and that he already tested negative for SARS-CoV-2, the virus that causes COVID-19.“We also found out that the billing and finance department of the hospital falsified documents in an attempt to prove that the patient died of COVID-19. They forged the signatures of a doctor and the representative,” Pura said.

The regional office of PhilHealth said it would respond to the allegations in the Ombudsman. “We will answer the charges in the right forum,” it said in a statement.

A Chong Hua representative said the hospital would send a statement “anytime soon.” But as of 5 p.m. on Tuesday, the Inquirer had not received any statement.

Last year, the NBI filed graft cases against officials and employees of PhilHealth in Central Visayas and of Perpetual Succour Hospital Inc. for “upcasing” a fraudulent activity in which conspirators upgrade a patient’s case to claim more reimbursements. INQ

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TAGS: COVID-19 claims, hospital ofificials, Philhealth, PhilHealth anomalies
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