The National Bureau of Investigation (NBI) in Central Visayas filed a complaint against a private hospital in Cebu and several officials of the Philippine Health Insurance Corp. (PhilHealth) for alleged graft and corrupt practices and malversation of public funds at the Office of the Ombudsman-Visayas, on Monday, Feb. 8.

Arnel Pura, NBI Central Visayas executive officer and supervising agent, said charges were filed based on “documentary and testimonial evidence” of alleged fraudulent and irregular facilitation and processing of PhilHealth claims involving a 41-year-old deceased patient from Cogon in Carmen, Cebu.

Pura said the private hospital, later identified as Chong Hua Hospital, allegedly “falsified Covid-19 claim,” as documents showed the patient died of kidney failure and not because of Covid-19.

The claim, “which covers frontlines and health workers afflicted with Covid-19,” was processed although the patient was not qualified, the agent said.

“We have obtained certification from SSS (Social Security System), BIR (Bureau of Internal Revenue), LGU (local government unit) Carmen, including the barangay (where the patient resided), attesting to the fact that he is not working (as a frontliner),” Pura explained.

The family of the patient told NBI Central Visayas that the hospital bill was more than P197,000. The family signed a promissory note and paid only a partial amount of P76,000, he said.

Pura said the hospital later informed the family that PhilHealth had reimbursed them the amount of P108,000. “They (the family) found it surprising because they have to pay for the balance,” he said. For kidney patients, PhilHealth can only cover P11,000 of the total bill, he added.

The case was just one of six cases the NBI in Central Visayas was looking into following President Rodrigo Duterte’s order to investigate PhilHealth’s alleged anomalies.

NBI Central Visayas received last year at least 30 boxes containing similar cases.

In a statement, the regional PhilHealth office did not comment on the allegations. It clarified that it would continue to abide by guidelines in processing claims based on internal circulars issued by its board.

The agency said it ceased shouldering the full cost of Covid-19 patient treatments starting April 14, 2020.

However, it said it would continue to “provide financial coverage” through a “recomputed case rate.”

In a statement, Chong Hua Hospital said it “categorically denies any mishandling of PhilHealth benefits” of their patients.

The hospital said claims filing and reimbursement procedures of Covid-19 patients were “fully compliant” with PhilHealth guidelines.

It added that the hospital was “initially disappointed” with NBI Central Visayas for giving “merit to the accusations.”

“We are fully confident that a fair, impartial, and politically unprejudiced investigation will absolve us of any anomalies and vindicate our good name,” the statement read. Ryan Sorote

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