CEBU CITY – The National Bureau of Investigation-Central Visayas (NBI-Region 7) has filed administrative and criminal charges against officials and personnel of the Philippine Health Insurance Corp. (PhilHealth) and a private hospital here for alleged irregularities in the disbursement of COVID-19 claims.
In a report submitted to Deputy Ombudsman for the Visayas Paul Elmer Clemente, the NBI Region 7, headed by Regional Director Renan Oliva, found that officials and personnel of PhilHealth-Central Visayas and Adventist Hospital in Cebu City colluded with each other in releasing more than P300,000 in COVID-19 claims to a hospital patient.
Allegedly involved in the anomaly were PhilHealth Region 7 officials Arlan Granali, acting regional vice president; Francis Javier, division chief; Joan Tiu-Ayuson, medical specialist; Josette Bacalso, fiscal controller; Anecito Camahalan Ramas Jr., social insurance officer; Anthonneette Lerios Maamo, clerk; Nina Christine Alkuino Lunday, social insurance officer; and Kenneth Aguilar Donalvo, social insurance officer.
It was not the first time that NBI Region 7 has filed cases against some of the PhilHealth Region 7 and hospital officials over the same issue.
Officials and personnel of Adventist Hospital charged were Dr. Michelle Jay Francisco-Napigkit, attending physician; Cefriano Julian Jr., chief of the Patient Business Department; Kenneth La Sage, clerk of the PhilHealth Section; Dicchel Grace Napigkit and Red Ford Gargarila, both billing clerks, and nurse Romeo Rando Jr.
The charges were filed after the NBI Region 7 investigated a “randomly forwarded and approved claim” of Adventist Hospital to PhilHealth Region 7 involving the medical case of a retired Bangko Sentral ng Pilipinas (BSP) employee.
The patient experienced cough and shortness of breath and was found to have “ambulatory and acute respiratory failure secondary to pulmonary tuberculosis” when he was admitted at the Adventist Hospital from May 27 to 28.
The patient underwent two COVID-19 tests – the antibody test and the real-time polymerase chain reaction (RT-PCR) test. The patient died in the hospital on May 28.
The NBI Region 7 said the result of the antibody test released on May 27 showed that the patient tested negative for COVID-19.
According to the NBI Region 7, Francisco Napigkit, the attending doctor, “certified” in the death certificate that the cause of death was “COVID pneumonia probable severe.” On June 3, result of the RT-PCR test from the Vicente Sotto Memorial Medical Center here showed that the patient was negative for COVID-19.
Despite the two negative tests, the death certificate showing that the patient died due to COVID-19 was still forwarded to the Office of the Civil Registrar-Cebu City.
On the June 15, the same death certificate was submitted to PhilHealth used as basis to claim the benefit package amounting to P335,519.
The NBI Region 7 said officials and personnel PhilHealth Region 7 and the hospital involved in the case committed “upcasing” or the claiming of a related illness or procedure of a higher severity to gain higher benefit “as it is apparent that he (patient) was not a COVID-19 patient based on the two negative test results.” The NBI Region 7 said the PhilHealth officials were charged for violating Republic Act (RA) No. 3019 or the Anti-Graft and Corrupt Practices Act and malversation of public funds.
Administrative charges for dishonesty, neglect of duty, misconduct, inefficiency, and incompetence in the performance of official duties and for violation of RA 6713 or the Code of Conduct and Ethical Standards of Public Officials and Employees were also filed.