DOJ indicts WellMed co-owner, 2 whistleblowers over PhilHealth 'ghost claims'

Mike Navallo, ABS-CBN News

Posted at Jun 14 2019 08:11 PM | Updated as of Jun 14 2019 08:47 PM

MANILA—The Department of Justice has indicted the co-owner of the dialysis center accused of making ghost claims with PhilHealth, and the two whistleblowers who exposed the alleged scam.

In an 8-page resolution released Friday, Senior Assistant State Prosecutor Anna Noreen Devanadera found probable cause to file separate information or criminal charges against WellMed Dialysis Center co-owner Dr. Bryan Christopher Sy, and whistleblowers Leizel Aileen de Leon and Edwin Roberto for estafa through falsification of official documents.

Devanadera cited the admission of Roberto and de Leon, who claimed that they followed Sy’s instruction to prepare several PhilHealth forms and falsify these documents by “counterfeiting or imitating signatures and making untruthful statements” supposedly for fear of losing employment and under threats from Sy.

“They basically declared that it was respondent Sy who principally orchestrated the falsification of the Philhealth benefit claims documents to make it appear that the deceased patients were still alive and were availing of the allotted dialysis sessions,” the resolution said.

Devanadera said the documents allegedly falsified by the respondents are considered official documents under the law, because the moment they were submitted to PhilHealth to secure benefit claims, they became part of the records of PhilHealth and became official or public documents.

“Respondents then, with full knowledge that said official documents were falsified, subsequently used and applied with Philhealth that they be paid for the dialysis sessions allegedly used by the deceased patients. These documents were submitted by respondents, with respective certifications and was able to successfully claim form Phihealth on different dates,” the resolution said.

According to the resolution, the NBI submitted copies of death certificates of deceased patients and sworn statements from PhilHealth officials and the whistleblowers.

Based on documents presented, PhilHealth paid WellMed a total of P600,600 covering 9 patients and the clinic had pending claims amounting to P208,000 for 5 patients as of March 2018, just before they left the clinic.

Aside from claims supposedly made by dead patients, the whistleblowers said there were also instances when WellMed claimed payments for more sessions of dialysis that actually rendered or claimed the entire annual allowable dialysis sessions in full without patient’s knowledge.

In the same resolution, the prosecutor said the complaints for the 7 other respondents who are not under custody will go through preliminary investigation, which means criminal charges will have to be filed in court before they can be arrested.

These respondents are other officers of WellMed: Dr. John Ray Gonzales, medical director; Claro Sy, chairman; Alvin Sy, corporate treasurer; Therese Francesca Tan, purchasing officer; Dick Ong, administration officer; and physicians Dr. Porshia Natividad and Joemie Soriano.

 
VALID WARRANTLESS ARREST

Sy, Roberto and de Leon were arrested without a warrant Monday while attending the probe of the NBI.

Sy had tried but failed to question the validity of his arrest before a Manila court and the inquest proceedings on Tuesday.

In the resolution, Devanadera justified the warrantless arrest saying it was a case of hot pursuit under Rule 113, sec. 5(b) of the Rules of Court.

She said NBI personnel had personal knowledge that the respondents were “probably still continuously filing false claims with Philhealth last June 7, 2019” citing a certification from PhilHealth submitted by PhilHealth investigator John Cueto.

“Thus, when Cueto was able to secure a copy of the certification of continuous filing of benefit claims – the most recent of which was last June 7, 2019 – the NBI was able to determine based on their personal knowledge that a crime has just been committed,” she said.

On Wednesday, NBI Spokesperson Ferdinand Lavin said Sy was caught as if in the act of committing a crime because WellMed still had existing ghost claims with PhilHealth.

However, a copy of the PhilHealth certification obtained by the media Thursday did not mention any “ghost claims.”


NO INFORMATION FILED IN COURT YET

Despite the release of the resolution Friday, Devanadera and lawyer Rowell Ilagan, Sy’s counsel, both confirmed no information or criminal charge has yet been filed in court.

Ilagan’s co-counsel, lawyer Kristian Vicente Gargantiel, on Thursday asked the Justice Secretary Menardo Guevarra and NBI Director Dante Gierran to immediately release his client because more than 36 hours had lapsed and no criminal cases had yet been filed against him.

Under Article 125 of the Revised Penal Code, a person can only be detained without charge up to a maximum of 36 hours from arrest.

DOJ Spokesperson Usec. Markk Perete said the DOJ is still evaluating Sy’s request.

Guevarra said "nothing prevents the accused from applying for bail anytime between the issuance of the resolution finding probable cause and the filing of the information in court."

While the DOJ’s resolution did not mention any amount of bail recommended, according to Devanadera, they have recommended bail at P72,000.