Hospital clerk convicted of falsifying dialysis claims

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MANILA, Philippines — A hospital clerk has been convicted of 46 counts of falsifying official documents after he submitted forged reimbursement claims to the Philippine Health Insurance Corp. (PhilHealth) for 12 hemodialysis patients who were already dead.

In a 20-page decision promulgated on July 31, Pasig City Metropolitan Trial Court Branch 153 presiding Judge Jesusa Lapuz-Gaudino found Svend Agodilos Rances guilty of falsifying public documents to get reimbursements for hemodialysis treatment and hospital services from PhilHealth using the names of patients who had passed away.

Rances was sentenced to a prison term ranging from a minimum of six months to up to three years and six months for each count, on top of a P50,000 fine.

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The case against him was filed by the Pasig prosecutor’s office in 2020 based on the complaint of Dr. Gjay Ordinal, a nephrologist for nearly two decades. The doctor was also the president and authorized representative of TriHDCare Inc., which manages the hemodialysis unit at TriCity Medical Center and where Rances worked from 2016 to 2019.

His duties as the facility’s PhilHealth clerk included processing hemodialysis claims with the state health insurer to allow the hospital to seek reimbursements for treatment given to qualified member-patients.

Rances, according to Ordinal, was responsible for preparing the necessary documents and filling out the forms based on the information provided by the PhilHealth member or patient.

He would then have the forms signed by the signatories before filing and transmitting the claims documents by uploading them to the PhilHealth system.

Certified true copies

Ordinal said the claim signature form, PhilHealth benefit eligibility form, and statement of account were the three official documents that should be filed with the state health insurer by the hospital to get reimbursements.

He added that they only learned about the documents forged by Rances in April 2019, when PhilHealth required the hospital to submit certified true copies of the claim forms and medical records of two patients.

This was after the state health insurer found out that reimbursement claims had been filed in their names when PhilHealth records showed both were dead.

During an investigation conducted by the hospital, Rances admitted that he filed false claims to make it appear the two patients had undergone dialysis even though they had passed away even before the supposed treatment dates.

In one of the written statements submitted by the accused, he said the reimbursement claims for both patients were filed “ to compensate for claims that were not made for [March and April 2018.]”

‘Guilt acknowledged’

When asked in a meeting why the fraudulent claims were filed, Rances replied that he just made a mistake.

But upon further investigation, the hospital management discovered that he also filed claims with PhilHealth for 10 other deceased patients, aside from forging the signatures of Ordinal and the head nurse.

In convicting Rances, the Pasig court said the prosecution adequately proved the guilt of the accused by submitting the death certificates of the patients involved.

“Obviously, they could not have possibly signed any document, which leads to no other conclusion than that their signatures in the subject documents were forged,” it added.

The court noted that the testimonies given by Ordinal and other witnesses “did not suffer any material inconsistency as would affect their credibility.”

It also pointed out that Rances’ admission that he filed fraudulent claims with PhilHealth was “voluntarily and freely executed.”

“The declaration of an accused acknowledging their guilt of the offense charged… may be given in evidence against them,” the court said.

“The rationale for the admissibility of a confession is that if it is made freely and voluntarily, it constitutes evidence of a high order since it is supported by the strong presumption that no sane person of normal mind will deliberately and knowingly confess to a crime unless prompted by truth and conscience,” it added.