Philhealth 7, hospital officers charged for 'false' Covid-19 claim

·6 min read

THE National Bureau of Investigation (NBI) 7 filed on Monday, Feb. 8, 2021, criminal charges against eight officials of the Philippine Health Insurance Corp. in Central Visayas (Philhealth 7) and three officers and employees of Chong Hua Hospital in Cebu City for their alleged failure to identify falsified documents that made a patient appear that he tested positive for Covid-19 and was a frontliner.

The employees of Chong Hua Hospital (CHH) are the second batch of medical workers that the NBI 7 has charged in over three months.

The NBI 7, on Oct. 29, 2020, filed graft charges against four officers of Perpetual Succour Hospital in Cebu City and eight officials of Philhealth 7 for their alleged involvement in Covid-19 benefit claims anomalies.

Disappointed

In a statement, CHH expressed its disappointment over the NBI’s accusations. It denied any mishandling of the Philhealth benefits of its patients. The hospital remains hopeful that its integrity will prove its strict adherence to statutory and regulatory guidelines.

“While we are initially disappointed that the National Bureau of Investigation has given these accusations some merit, we are fully confident that a fair, impartial and politically unprejudiced investigation will absolve us of any anomalies, and vindicate our good name,” it said.

The Philhealth 7, for its part, said it continues to abide by the guidelines in processing claim documents as stated in the corporation’s circulars that were developed by its policy-making sector and approved by the Philhealth Board.

Ongoing inquiry

NBI 7 Director Rennan Augustus Oliva, a lawyer, said on Tuesday, Feb. 9 that the filing of the complaints was the outcome of their ongoing investigation on the Philhealth’s involvement in the irregularities of claims linked to Covid-19 funds.

“The patient was not a frontliner and was not Covid positive. Based on our investigation, he was unemployed and jobless for 10 years. He tested negative during the Covid test, but the claim still pushed through,” Oliva said.

Named respondents in the complaints are Philhealth 7 officials Arlan Granali (acting regional vice president), Dr. Francis Javier (Health Care Delivery Management Division chief), Dr. Joan Ayuson (Benefits Administration Section chief), Josette Bacalso (Fiscal Controller), Dr. Reginald Mangubat (Benefits Administration officer), Anecito Ramas Jr. (Social Insurance Officer), Anthonneette Maamo (Benefits Administration clerk), and Kenneth Donalvo (Social Insurance Assistant).

They were charged before the Office of the Ombudsman Visayas along with Sharon Rosales (CHH’s Philhealth supervisor), Jasmin Miguel (CHH finance manager) and Tiffany Bertulfo (CHH assistant vice president for finance).

Granali, Javier, Ayuson, Bacalso, Mangubat, Ramas, Maamo and Donalvo were also the co-respondents in the complaints filed against four Perpetual Succour Hospital officers.

The Philhealth 7 officials were charged for violating Section 3 (e) of Republic Act (RA) 3019, or the Anti-Graft and Corrupt Practices Act; malversation of public funds through falsification of public documents, a violation under Article 217 of the Revised Penal Code; violation of Section 4 of RA 6713, or the Code of Conduct and Ethical Standards for Public Officials and Employees; and gross and grave misconduct.

The three CHH officials were charged with violations of Section 3 (e) of RA 3019 and malversation of public funds through falsification of public documents.

Evidence

Oliva said they obtained the real information from the patient, Kim Solamo, through his certification from the Bureau of Internal Revenue and Social Security System and other barangay documents in the patient’s hometown in Carmen, Cebu.

Executive officer and supervising agent Arnel Pura said Solamo was confined in CHH Cebu City on March 30, 2020, after he complained of shortness of breath. For years, he had suffered from liver and kidney ailments. Solamo had been undergoing medical treatment to improve his medical condition, but his situation gradually deteriorated before he was brought to CHH.

However, Pura said they found an irregularity after examining the Philhealth claims forwarded by CHH on behalf of the patient. The claim, he said, lacked the mandatory requirements such as a positive Covid-19 test and a certificate of employment.

Pura said the hospital allegedly claimed P193,000 from the patient’s hospital bills amounting to P197,883.52.

The patient was then transferred to the Vicente Sotto Memorial Medical Center (VSMMC) in Cebu City on March 31, 2020 due to mounting hospital bills.

Upon the discharge of the patient from CHH, the family had a balance of P76,973.52. The patient’s transfer to the government hospital was granted after Solamo’s family executed a note promising to pay the balance in the future.

Solamo’s family later received from CHH P108,000 as reimbursement. This baffled the family, said Pura.

Solamo died 10 days after he was transferred to VSMMC.

The NBI 7 is still investigating other Philhealth claims related to Covid-19 cases in Central Visayas. Oliva hoped they would no longer encounter further irregularities.

Garcia’s statement

In a separate press conference, Cebu Gov. Gwendolyn Garcia lauded the NBI 7 for its relentless investigation.

“That is just the tip of the iceberg, and I hope that the NBI will continue its investigation. I commend the NBI for having the courage and the patriotism to file that case (because) this is robbing the national government. Kawat man ni harap-harapan (this is robbery right in front of us),” she said.

Garcia added: “Kang kinsa man pod ning kwarta? Taxes man na nato. Inyo man nang mga contributions sa Philhealth. Tua tanan nahurot anang packages nga perteng dagkoa. Unya, pag liquidate sa hospital diha na nisud ang corruption (Who owns this money? This came from our taxes. These are your Philhealth contributions. They are given away in big packages. Then, during the hospital’s liquidation, that’s when corruption comes in.)

The governor’s family filed on Dec. 15, 2020 criminal charges for medical negligence against two CHH Cebu City doctors—Dr. Elfleda A. Hernandez and Dr. Yvonne Bettina E. Montejo—over the death of Barili Mayor Marlon Garcia.

The charge for medical negligence against Hernandez and Montejo was based on the findings of Dr. Ravi Durvasula, a licensed physician and professor of Medicine and Infectious Disease and chairman of the Department of Medicine of Loyola University Stritch School of Medicine in Chicago, USA.

Durvasula’s findings show the lack of observance of standard care and procedure, employment of highly questionable and unnecessary laboratory tests and treatments, and exaggerated or unsupported laboratory results which led to the death of the late mayor.

Chong Hua Hospital defended Hernandez and Montejo, saying there were no irregularities or shortcomings.

Marlon died on Sept. 6, 2020, five days after the death of his older brother Nelson. Both died while confined in Chong Hua Hospital in Cebu City. (JOB with ANV)