Nalzaro: PhilHealth and hospital collusion?

·3 min read

Corruption is, indeed, the root of all evil that even religious-run institutions are not spared the allegations. Corruption in government is already a part of our system. We all know how the country, especially government bureaucracy, suffers from widespread corruption. You see, a religious-run hospital is allegedly in cahoots with corrupt government officials in committing an anomaly in the release of fraudulent claims from the Philippine Health Insurance Corp. (PhilHealth) 7.

The National Bureau of Investigation (NBI) 7 filed the first case it investigated in connection with the anomalies involving PhilHealth on fraudulent claims by some hospitals regarding coronavirus patients. The NBI 7 filed cases before the Office of the Ombudsman-Visayas against eight officers of the state insurer and four private individuals, including a nun of Perpetual Succour Hospital, for violation of Republic Act (RA) 3019, or the Anti-Graft and Corrupt Practices Act; RA 6713, or the Code of Conduct and Ethical Standards of Public Officials and Employees; and malversation of public funds under Article 217 of the Revised Penal Code.

The PhilHealth 7 officers were also charged administratively for violation of Executive Order 292 or the Revised Administrative Code of 1987, for dishonesty, neglect of duty, misconduct, inefficiency and incompetence in the performance of official duties and for conduct prejudicial to the best interest of the service with the extreme penalty of dismissal from service.

Here’s a synopsis of the case.

Patient X, single, and a resident of Casili, Consolacion, was brought and confined at the Perpetual Succour Hospital last May 14 and 16. The patient was suffering from stage 4 cancer in his gallbladder and was undergoing chemotherapy. Prior to his confinement at the Perpetual Succour, Patient X was first brought to the Mendero Medical Center in Consolacion after he experienced abdominal pain.

While at Mendero, the patient was subjected to a rapid test for Covid-19 where he was found negative. Since his condition deteriorated, he was brought to Perpetual Succour on May 14.

There, he was again subjected to a rapid test and the result was still negative. During confinement, the patient was again subjected to a Reverse Transcription-Polymerase Chain Reaction test. The result came out on May 18 and he was again negative. However, the patient died on May 16. In his death certificate, his doctors said he died due to acute respiratory failure Type 2 to community acquired pneumonia, Intrahepatic cholangiocarcinomia stage 4 with hepatic carcinomatosis and Covid probable.

NBI 7 investigators were puzzled why the hospital put “probable Covid-19” as cause of his death when the patient was found negative in a series of tests. Since the patient was categorized as a “severe pneumonia” case, the hospital was able to claim a higher financial package from PhilHealth in the amount of P333,519. PhilHealth released the amount without even bothering to check the patient’s hospital records, which did not indicate that he died of Covid-19, the NBI 7 said.

The other financial packages under PhilHealth Advisory 2020-020 are as follows: P43,997 for patients with mild pneumonia confined in Level 1 to 3 hospitals; P143,267 for patients with moderate pneumonia in Level 1 to 3 hospitals; P333,519 for severe pneumonia, including ICU; and P796,348 for patients with critical pneumonia in Level 1 to 3 hospitals, including ICU.

And hold your breath, in the two days the patient was confined, his bill reached P161,073 plus professional fees amounting to P100,055 for five attending doctors that totalled P261,128.00.

The NBI 7 described the claim as “upcasing.” Meaning, the claim was bloated. The hospital, the NBI said, refunded the patient’s family P18,000 only. Now, who was really responsible for the fraudulent claim? Did the hospital administration, which is run by a religious sector, have nothing to do with the anomaly?