CASE BUILDUP An agent of the National Bureau of Investigation in Central Visayas checks the documents of the complaint
lodged before the Office of theOmbudsman in the Visayas on June 29 against PhilHealth and Adventist Hospital Cebu officials involving alleged fraudulent COVID-19 claim. —PHOTO COURTESY OF NATIONAL BUREAU OF INVESTIGATION CENTRAL VISAYAS
CEBU CITY—The National Bureau of Investigation in Central Visayas (NBI-7) has lodged before the Office of the Ombudsman criminal and administrative complaints against eight regional officials of the Philippine Health Insurance Corp. (PhilHealth) and six personnel of a private hospital over alleged irregularities in the disbursement of COVID-19 claims.
Lawyer Rennan Augustus Oliva, NBI-7 director, said the officials of PhilHealth in Central Visayas and the privately run Adventist Hospital in Cebu City allegedly conspired to make a P335,519 COVID-19 claim for a patient who allegedly did not die of the disease.
“This is the third case we are filing (involving alleged) corruption and irregularities within PhilHealth, as well as, in this particular case, the Adventist Hospital Cebu,” Oliva said at a press conference on Thursday, two days after the NBI-7 lodged the complaint before the Office of the Ombudsman in the Visayas.
Officials of the Adventist Hospital declined to comment on Friday, saying they have yet to receive a copy of the complaint.
Respondents
PhilHealth officials in the region insisted they had not violated any law.
“In view of the recent allegations of NBI-7, PhilHealth-7 sticks to its previous statement that it continues to abide by the guidelines in processing claim documents per published circulars which are developed by its policy-making sector and are approved by the PhilHealth board,” said Edwin Orina, regional vice president of PhilHealth, in a statement on Friday.
“PhilHealth Circular No. 2020-009 entitled ‘Benefit packages for inpatient care of probable and confirmed COVID-19 developing severe illness/outcomes,’ was the basis of the regional office in processing claims,” he added.
Named respondents in the complaint were PhilHealth-7 acting regional vice president Arlan Granali, division chief Francis Javier, medical specialist Joan Tiu-Ayuson, fiscal controller Josette Bacalso, social insurance officer Anecito Camahalan Ramas Jr., clerk Anthonneette Lerios Maamo, social insurance officer Nina Christine Alkuino Lunday, and social insurance officer Kenneth Aguilar Donalvo.
The NBI-7 also identified as respondents officers and personnel of Adventist Hospital, namely, attending physician Dr. Michelle Jay Francisco-Napigkit, chief of the patient business department Cefriano Julian Jr., clerk of PhilHealth section Kenneth La Sage, billing clerks Dicchel Grace Napigkit and Red Ford Gargarila, and nurse Romeo Rando Jr.
They were accused of violating the Anti-Graft and Corrupt Practices Act and for malversation of public funds. A separate criminal complaint was filed before the antigraft body against Francisco-Napigkit for allegedly issuing false medical certificates.
Administrative charges were likewise filed against the PhilHealth respondents for violating the code of conduct and ethical standards of public officials and employees.
‘Upcasing’
The case involved a retired Central Bank employee who was confined at the Adventist Hospital from May 27 to May 28, 2020, due to cough and shortness of breath.
The male patient was initially diagnosed with “ambulatory and acute respiratory failure secondary to pulmonary tuberculosis.”
The NBI-7 said the patient tested negative for COVID-19 on May 27, 2020. The next day, the patient died in the hospital.
The NBI-7 said Francisco-Napigkit certified in the death certificate that the patient’s immediate cause of death was “COVID pneumonia probable severe.” But on June 3, 2020, the result of the reverse transcription polymerase chain reaction ( RT-PCR) test from the Vicente Sotto Memorial Medical Center laboratory showed the patient was negative for COVID-19.
On June 15, 2020, the patient’s death certificate was submitted to PhilHealth as basis to claim the benefit package totaling P335,519.
“(This is) a clear case of ‘upcasing’ or the claiming of a related illness or procedure of higher severity to gain higher benefit payment, as it is apparent that he is not a COVID-19 patient based on the two negative test results,” the NBI-7 investigators said. INQ