SOME local government units (LGUs) are behind the “recruitment” of patients who are subjected to unnecessary medical procedures whose cost will be partly shouldered by the Philippine Health Insurance Corporation (Philhealth), an official of the Department of Health (DOH) revealed Wednesday.
During the continuation of the Senate blue ribbon investigation on questionable Philhealth claims, Dr. Ma. Dominga Padilla, head executive staff at the DOH, said some LGUs are using government resources and even employees to recruit patients in barangays (villages) and bring them to a private hospital or ambulatory surgical center to undergo surgery that will be charged later to Philhealth.
Padilla, also the president of the Philippine Eye bank, added that private hospitals and clinics are usually owned either by relatives or business partners of a local government official.
Philhealth-sponsored patients are being enticed or even paid to undergo surgery even if they don’t need it, Padilla said.
“Private health care institutions earn hundreds of millions while depriving government hospitals of potential income,” Padilla said.
The DOH official cited the case of Romeo Fernando, who was referred by the Pasay City government to the Borough Medical Care Institute at the Mall of Asia in Pasay City in 2012 for an eye checkup.
Fernando reportedly underwent two eye operations in three months but his right eye was blinded after an operation.
When the patient asked for a second opinion, he was referred by the Pasay City government to the Pasay City General Hospital.
“Why was he referred to a specific private eye clinic? Now when the patient got complications they sent him to Pasay City General to see an ophthalmologist about the complication. That means Pasay general has an ophthalmologist who can treat,” Padilla said.
Padilla, however, clarified that she is not saying that such practice is common but there are local officials who are involved in the Philhealth claims scam.
“I think the Philippine Academy of Ophthalmology can give you some list but I’m not ready to say them in public,” she added.
Senate President Pro Tempore Ralph Recto asked PhilHealth to look deeper into the fraudulent payments it made to private clinics and hospitals to find out if recipients of multi-million-peso reimbursements had help from the inside.
According to Recto, two-thirds of PhilHealth reimbursements went to the private sector “and it seems that claims applied for by them were acted somewhat expeditiously by PhilHealth.”
“Isn’t this a tell-tale sign that there could be expediters inside PhilHealth?” Recto said, addressing Philhealth Chief Operating Officer (CEO) and President Alex Padilla.
Padilla said their investigation showed no collusion from within the agency.
“We followed the money and all the money went to private health care institutions,” Padilla said, adding that most of the erring parties were private health care providers.
To deter scams, Recto said stiffer fines must be imposed “because what’s being stolen here is taxpayer’s money and what is stolen from pool reduces the resources which can be given to deserving claimants.”
Recto also noted that payouts involving indigents, at P25 billion last year, was smaller than the P37 billion that government shelled out in premium cost for indigents it enrolled in PhilHealth during the same year.