Probe vs 'ghost dialysis' scheme delayed due to red tape: Philhealth exec

ABS-CBN News

Posted at Jun 07 2019 12:19 PM | Updated as of Jun 07 2019 02:00 PM

MANILA - The Philippine Health Insurance Corporation has been investigating the "ghost dialysis" scheme since 2018, but probes have been stalled by difficulties in obtaining death certificates, the health agency's spokesperson said Friday.

Since December 2018, at least 10 fraud cases have been filed against WellMed Dialysis Center, but its accreditation has yet to be suspended as officials are not yet done with the case build-up, Dr. Shirley Domingo, Philhealth spokesperson and vice president for corporate affairs, told DZMM's Failon Ngayon.

"The delay was getting death certificates from PSA (Philippine Statistics Authority). We even requested the families to help us, authorize us in getting the certificates," Domingo said.

The issue resurfaced about 6 months since it was first brought to the Philhealth's attention after Edwin Roberto, a former WellMed employee, divulged the scheme to broadsheet Philippine Daily Inquirer.

"More or less 10 patients na patay na pasyente nafile-an po namin ng additional benefits. Ang ibig sabihin po noon, kahit na patay na nung 2016, file pa rin ng 2017. Continuous po siya kasi wala namang audit ang PhilHealth sa amin," he said.

(We filed additional benefits for around 10 patients that were already dead. This means that even if the patient died in 2016, we still file for claims in 2017. It's a continuous cycle because PhilHealth does not audit us.)

Nearly a year since Roberto first approached Philhealth about the scam, the insurance corporation has yet to assess how much money was lost through the filing of fraudulent claims.

"Kino-collate pa kung magkano. Wala pa ang data sa atin ngayon [kasi] may pending po tayo na 12 cases... We will come out with that data before the end of the day," Domingo said.

(We are still collating how much. We do not have the data yet because we still have 12 cases pending. We will come out with this data before the end of the day.)

Twenty other cases were filed against doctors who signed the allegedly fraudulent claims, she said.

Philhealth has held off payments to WellMed Dialysis Center while investigations are ongoing, but it remains to be an accredited facility, she said.

"Ang policy nila, once a case is filed in the Arbitration [Department] then we can suspend, pero kung case build up pa tayo, hindi pa natin tinatanggalan ng accreditation iyon," she said.

(The policy is once a case has been filed in the Arbitration Department then we can suspend, but if were still in case build up, we can't remove accreditation yet.)

The agency earlier said it was investigating 2,000 health providers on possible fraudulent claims.