How doctors dupe patients for PhilHealth claims revealed

Warning for cataract patients: If a doctor tells you to come back for a laser treatment shortly after an operation, then it’s a scam, an official of the Department of Health (DOH) told a Senate hearing on Wednesday.

DOH Assistant Secretary Dr. Ma. Dominga Padilla, also president of the Philippine Eye Bank, said that some patients were told by their doctors immediately after a cataract surgery to return after two weeks or a month for a laser treatment.

“Inoperahan nila, hindi nila pina-follow up when they should, which is between 48 hours. Pinababalik after two weeks or a month para lang i-laser, para kumita ulit. It’s very, very unlikely na merong ng indication for a laser at that point in time…” Padilla said.

(The doctors operate on their patients, but they do not follow up on them when they should, which is between 48 hours. They make them return after two weeks or a month to perform a laser procedure so they will make money again. It’s very, very unlikely that there is an indication for a laser at that point in time.)

She said it was very rare that cataract complications would develop a year after the surgery but it was even “more questionable,” she said, if a doctor would tell his or her patients immediately after the operation to return for a laser treatment.

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“Parang pini-predict mo na na magkaka-kumplikasyon s’ya (It’s like your predicting they will suffer complications), which is long term complication, then you have them come back two weeks after or one month after? In other words, it’s a scam. This is definitely a scam,” Padilla said.

“It’s something you don’t predict, it’s something you don’t want to happen because it’s a complication of a cataract surgery so you don’t tell the patient to come back just to be lasered,” she added.

Dr. Robert Louie So of Philippine Health Insurance Corporation’s (PhilHealth) internal audit group pointed out that cataract complications usually develop six months to five years after the operation.

But this was not the case of Romeo Fernando, who had his eye checked at the Borough Medical Care Institute at the Mall of Asia in Pasay City in 2012 but ended having his right eye blinded after an operation.

After a successful operation on his left eye, Fernando said his doctor, a certain Dr. Olalia told him to come back after three months for another operation on his right eye

But when he came back, it was another doctor, Dr. Cabrera, who worked on his right eye. It was then that he started feeling some problems that he decided to seek a second opinion in other centers until someone suggested him to go to the Pacific Eye Center, where four laser treatments were conducted on his eyes.

When the doctors at the Philippine General Hospital checked on his condition, Fernando said he was told that his iris on his right eye was damaged by the operation.

So said that based from their claims data, Fernando had for laser treatments two years after his operations — on February 27, 2014; March 25, 2014, April 8, 2014, and April 22, 2014.

“This was done two years after pero what’s notable po sa audit namin was that, ‘yung ginawa po sa left eye na YAG laser capsulotomy was done (almost one month apart)…” he said.

So also believes that that a laser treatment on the blind right eye was unnecessary.

“Una po, ‘pag bulag na po ang mata at ni-YAG laser capsulotomy pa po, mukhang hindi na po kailangang gawin ‘yun at nag-claim pa po sa amin…” he further said.

(If a patient is already blind, and you still perform a YAG laser capsulotomy, that is already unnecessary, but they still do it so they can claim money from us.)

Another patient, Bonifacio Martinez, said he also ended up blind after undergoing a cataract surgery by a certain Dra. Ruby Reyes also at Borough Medical.

After telling him that he could no longer see, Martinez said his doctor gave him an envelope containing P10,000.

“Tulong n’ya daw ‘yun (It was his way of helping),” he told the committee.

After that, Martinez said his doctor disappeared and no longer answered his phone calls. IDL