Senators told of botched eye surgeries, PhilHealth fraud | Inquirer News

Senators told of botched eye surgeries, PhilHealth fraud

One senior citizen lost his right eye while another ended up blind after undergoing cataract operations that were either unnecessary or not properly followed through by their doctors.

And yet their operations were fully paid for by the Philippine Health Insurance Corporation (PhilHealth).

And then there was the patient who complained that the eye doctor claiming payment from PhilHealth was not the same doctor who operated on her.


These were among the stories that came out at the second hearing of the Senate blue ribbon committee that is looking into the suspicious claims that certain hospitals and clinics have filed with PhilHealth amounting to P2 billion, and other similar fraudulent transactions.


Cataract operations

The committee is looking in particular at PhilHealth claims involving cataract operations.

Romeo Fernando, a PhilHealth member, told the committee how he went to the Borough Medical Care Institute in 2012 which performed a cataract operation, first on his left eye, and three months after, on his left eye. He was told he did not have to return after the surgeries.

When he had trouble seeing properly, Fernando went to the Pacific Eye Institute. There, he underwent four laser treatments on the left eye. Doctors there told him they could do nothing more about his right eye. He was asked to shell out money for injections to improve his eyesight but he declined because he said he had no money for it.

Fernando said he then went to the Philippine General Hospital where doctors told him there that his iris had been pierced and damaged and that they could no longer do anything about it.

According to Dr. Robert Louie So, the PhilHealth vice president for internal audit, Fernando ended up blind in his right eye.


Laser treatments

Based on his claims data with PhilHealth, Fernando had cataract operations in 2012 in the right and left eyes. In 2014, there were claims for four laser treatments, two of which were said to be due to complications of cataract operations and done almost one month apart, according to So.

Fernando also underwent on March 6, 2014, a laser treatment for his right eye, which was already blind, said So.

“We believe that the operation was unnecessary because the eye was already blind and a laser operation was not needed,” So said.

The two laser treatments which were done one month apart on Fernando’s left eye, meanwhile, “raises a red flag,” as complications of cataract develop normally after five to six years, said So.

Dr. Ma. Dominga Padilla, Department of Health head executive staff and president of the Philippine Eye Bank, said laser treatment done too soon after a cataract operation was “dangerous for the patient” because the lens are not yet stable for a laser operation.

“In other words, it’s a scam. If your doctor tells you right after surgery to return for a laser operation because it’s something you don’t predict, it’s something you don’t want,” Padilla said.

And because this has become an “abused procedure,” PhilHealth now has a new guideline where it will not pay for claims for a laser operations if done six months after a cataract operation, she said.

Blind witness

Another witness, Bonifacio Martinez, who is now blind, had his cataracts removed through a free operation sponsored by a politician in his barangay (village). Martinez had his operation at the Borough Medical Care Institute in April 2013. The surgery was performed by a certain Dr. Ruby Reyes.

“After a few days, I noticed spots on my eyes that eventually blocked my sight,” Martinez said. His doctor gave him some medicine but this did not help.

His doctor then asked him to go to the University of Santo Tomas hospital where doctors told him his eyes had a fungal infection. But it was too late to do anything about it, he was told.

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Martinez said Dr. Reyes made him sign papers that said Borough did not neglect him. She also gave him an envelope with P10,000 cash as “help.” He has not talked to or seen the doctor since.

TAGS: Doctors, fraud, Philhealth

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