PhilHealth scam probed

TUGUEGARAO CITY—The Philippine Health Insurance Corp. (PhilHealth) has recommended charges against a doctor and three others for an insurance scam that preyed on poor and old patients here.

PhilHealth has confirmed at least 54 cases of fake claims in 2016 amounting to P932,100 that implicated Dr. Christopher Ian Cabalza, a consultant of Tuguegarao City People’s General Hospital (TCPGH); Marites Attaban, a hospital clerk; and two other accomplices.

PhilHealth is also investigating 252 other cases of ghost claims of patients at TCPGH that may have defrauded the firm of P6 million, according to Oscar Abadu Jr., PhilHealth regional vice president.

“We suspect that we will find more cases, with more people involved. We suspect that this is just the tip of the iceberg,” he said.

Cabalza declined to issue a statement on advice of his counsel. Attaban, who had been placed under preventive suspension, could not be reached for comment.

Abadu said they were also looking into other suspicious claims made by three other doctors from 2013 to 2016. The claims reached P4.8 million.

Under the scheme, the suspects allegedly targeted poor and old patients from the city’s nine villages who were listed under the PhilHealth’s mandatory coverage of indigents and senior citizens.

The recruited PhilHealth members were then made to sign forms indicating they were confined for various ailments at TCPGH for which they were entitled to health benefits.

The suspects also prepared fake receipts to make it appear that the supposed patients bought medicines from pharmacies outside the hospital that would be added to their claim for PhilHealth reimbursement.

Any amount reimbursed in favor of the city government would then be encashed and divided among the fake patients, the agents and the hospital personnel, according to a PhilHealth investigation report.

The report matched the initial results of an inquiry made last month by the city council, after PhilHealth refused to grant TCPGH an accreditation when the supposed ghost claims surfaced.

“We will also be filing criminal and administrative charges against all participants in this scam, as well as seek the revocation of license of doctors involved,” said acting Vice Mayor Jude Bayona, who led the city council’s investigation.

The city government also asked the PhilHealth central office to reconsider its denial of TCPGH’s accreditation.

“(TCPGH) is [the] most accessible and most affordable [health facility here] being a government hospital, so it is usually preferred by the people of Tuguegarao, especially among the poor who are dependent on PhilHealth subsidy for their hospital expenses,” Abadu said.