PhilHealth, PSH employees charged for ‘anomalous’ Covid-19 claims

Wenilyn Sabalo
·5 min read

THE National Bureau of Investigation (NBI)-Central Visayas filed on Thursday, Oct. 29, 2020, several complaints against eight officials of the Philippine Health Insurance Corp. in Central Visayas (PhilHealth 7) and four officials and employees of Perpetual Succour Hospital (PSH) in Cebu City for their alleged involvement in Covid-19 benefit claims anomalies.

PhilHealth 7 officials Arlan Granali (acting regional vice president), Dr. Francis Javier (HCDMD division chief), Dr. Joan Ayuson (Benefits Administration Section chief), Josette Bacalso (Fiscal Controller), Dr. Reginal Mangubat (Benefits Administration officer), Anecito Ramas Jr. (Social Insurance Officer),

Anthonneette Maamo (Benefits Administration clerk), and Kenneth Donalvo (Social Insurance Assistant) were charged by NBI before the Office of the Ombudsman Visayas along with Sr. Brenda Mondares (PSH financial management manager), Gladys Sarmiento (assistant department manager), and PSH billing officers Jaye Anne Arañas and Gina Misagal.

The charges include violations of Republic Act 3019, or Anti-Graft and Corrupt Practices Act, Code of Conduct and Ethical Standards of Public Officials, and malversation of public funds.

Administrative cases were also filed against them for violation of the Revised Administrative Code for Dishonesty, Neglect of Duty and Misconduct, incompetence in the performance and inefficiency in official duties, and conduct prejudicial to the best interest of the service.

Ordinary cases

Lawyer Reynan Augustus Oliva, NBI-Central Visayas director, said there were instances when PSH patients who could have just been considered as ordinary pneumonia were referred to PhilHealth as Covid-19 cases.

Lawyer Wenceslao Galendez, the supervising NBI agent for one of the Covid-19 benefit claims being investigated, cited the case of a patient, whom he called Patient X.

Galendez said Patient X who suffered from stage 4 cancer was originally admitted at Mendero Medical Center in Consolacion town, northern Cebu, on May 14.

Galendez said upon the patient’s admission at Mendero Hospital, he was subjected to a rapid test for Sars-CoV-2, the virus causing Covid-19. The test yielded a negative result.

Patient X was then moved to PSH and subjected to another rapid test on May 15 where he again tested negative.

On May 16, the patient died. The cause of death was listed as acute respiratory failure-secondary to community acquired pneumonia.

Because the patient had a pre-existing medical condition (stage 4 cancer), Galendez said he was considered Covid-probable upon death.

He pointed out that the patient was confined in the hospital for only two days.

He said on July 19, PSH submitted to PhilHealth a severe pneumonia benefit claim amounting to P333,519.

Galendez said the claim filed by the hospital was erroneously approved by PhilHealth.

“He was subjected to rapid test twice by Mendero Hospital and also Perpetual both (yielded) negative (results) and he was also subjected to RT-PCR by Allegiant Regional Care Hospital in Lapu-Lapu City which was also negative. So, this is a clear example of upcasing,” he said.

Upcasing, as defined by PhilHealth, is a fraudulent practice of claiming for a related illness or procedure of higher severity than the actual to generate larger amounts of reimbursements.

In the case of Patient X, Oliva said the patient’s family was surprised to receive information from PhilHealth that severe Covid-19 claims amounting to P333,519 were credited to PSH.

When the NBI further inquired with the hospital and PhilHealth about the case, they were told they had merely forgotten to include the patient’s RT-PCR test showing that he had tested positive for Covid-19.

Oliva said this claim was not supported.

On the contrary, Oliva said PhilHealth officials neglected to review the most important document -- the RT-PCR (swab) test result that will determine whether or not the patient suffered from Covid.

More cases

The head of the NBI 7 added that the public could expect more cases to follow as Patient X is only one of the many claims being investigated at one case per patient per hospital.

“There is a likelihood that there are more cases being claimed as Covid when in fact, they are not,” Oliva said.

Oliva said the NBI district offices in Bohol and Dumaguete are also set to file cases relating to anomalous PhilHealth claims in the coming days.

PhilHealth-Central Visayas, for its part, said it has yet to receive an official copy of the complaints filed by the NBI-Central Visayas.

PhilHealth said it welcomed the NBI investigation and cooperated “in every possible way,” such as providing the NBI copies of claim documents and allowing access to PhilHealth’s warehouse to retrieve all necessary documents.

“It is unfortunate, however, that NBI-Cevro has chosen to resort to a virtual trial by publicity, as this inevitably tarnishes the integrity and reputation of the Regional Office and its employees, and leads to further social media backlash that does not distinguish between guilty and innocent,” PhilHealth said in a statement.

PhilHealth stood by its officers and employees in the regional offices saying “they abide by the guidelines in processing claim documents per published circulars of the corporation and per interim guidelines of the Philippine Society for Microbiology and Infectious Diseases on the clinical management of patients with probable or confirmed Covid-19 infection, and by existing government accounting and auditing rules on releasing payments.”

Meanwhile, Perpetual Succour Hospital told SunStar Cebu that it had yet to receive a copy of the NBI investigation report and the complaints filed against the officers and employees of the hospital and PhilHealth.

Jose Ray Bael, PSH legal counsel, said the hospital will issue an official statement upon receipt of the official complaint.