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Manila Bulletin devider Philippines devider National devider Pasig City hospital director, physicians, staff charged in 'ghost' PhilHealth claims

Pasig City hospital director, physicians, staff charged in 'ghost' PhilHealth claims

Published Sep 23, 2021 11:05 am

National Bureau of Investigation

Physicians, a board member, and personnel of a Pasig City hospital have been charged criminally before the Department of Justice (DOJ) for filing reimbursement claims with the Philippine Health Insurance Corporation (PhilHealth) for alleged non-existent or dead patients.

The respondents in the complaints filed by the National Bureau of Investigation-Anti-Graft Division (NBI-AGD) are connected with the Tricity Medical Center.

In a statement issued on Thursday, Sept. 23, the NBI said “there were at least 318 Fraudulent Claims with a total amount of P824,200 filed by Tricity Medical Center based on recorded dates of Hemodialysis Treatment after the death of patients.”

The NBI also said that “thorough investigation showed a strong possibility that the fraudulent claims could be higher is highly probable based on the 2016 to 2019 PhilHealth Database which showed a total of P4,308,000 involving several patients.”

NBI Officer-in-Charge Director Eric B. Distor said the respondents in the complaints are Dr. Enrico C. Cruz, hospital director and member of Tricity’s board of directors; hospital physicians Dr. Gjay Lalu Ordinal, Dr. Froilan Antonio De Leon and Dr. Lourdes Rhoda Reyes Padilla; hospital nurse Cherry Catalan Flores; Tricity PhilHealth staff Arlene Joy G. Sebuc; and hospital clerk Svend Agodilos Rances.

They were charged with estafa under Article 315(2) of the Revised Penal Code (RPC) and violations of Section 44 of Republic Act No. 7875, the National Health Insurance Act of 2013.

The NBI said “the investigation stemmed from an intelligence information received by the NBI-AGD on Jan. 8, 2020, alleging that Tricity Medical Center, Inc. situated in Pasig City has been fraudulently facilitating or claiming reimbursement from PhilHealth for its supposed hemodialysis patients which turned out to be non-existent or deceased already at the time of the supposed hemodialysis treatment.”

“Under the direct authority of the Director, the NBI-AGD conducted an investigation to determine the veracity of the information and to arrest those who are responsible for the fraudulent claims,” it said.

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