By Nancy Carvajal
The National Bureau of Investigation (NBI) has filed graft and other criminal charges before the Office of the Ombudsman against officials of a Cebu City hospital for allegedly making fraudulent claims to collect more money from PhilHealth.
The NBI said four employees of the Perpetual Succour Hospital connived with eight PhilHealth employees in Cebu City for “upcasing,” or the act of filing a claim for a more serious illness so the reimbursement from Philhealth will be bigger.
NBI Director Eric Distor said that upcasing of medical cases has been found to be one of the prevalent method used by health facilities in connivance with some Philhealth employees to defraud the state insurer firm.
The NBI-region 7 team in their report to the Ombudsman stated that “despite the patient’s negative test results for Covid- 19 virus, the hospital intentionally sent a fraudulent claim for reimbursement to Philhealth in the amount of P333,519 bills for a Covid- 19 severe Pneumonia package.
The amount which is ten times higher than the actual amount due to the hospital was “approved and released hastily by Philhealth, the NBI also said.
“A review done on the attachments would have led to Philhealth’s discovery that the patient’s illness falls only under its Updated Medical Case Rate Package for Pneumonia- High Risk for P32,000 only.’’
Charged for alleged violation of the Anti-Graft and Corrupt Practices Act, Code of Conduct and Ethical Standards of Public Officials and Employees, and Malversation of Public Funds were Arlan Granali (acting regional vice president), Dr. Francis Javier (HCDMD division chief), Dr. Joan Tiu-Ayuson (Benefits Administration Section chief), Josette Bacalso (Fiscal Controller), Dr. Reginal Mangubat (Benefits Administration officer), Anecito Ramas Jr. (Social Insurance Officer), Anthonneette Lerios Maamo (Benefits Administration clerk), and Kenneth Aguilar Donalvo (Social Insurance Assistant).
Also charge for conspiracy to commit fraud were; Sr. Brenda Monares, Succour Hospital Management Manager; Gladys Sarmiento; Jayanne Aranas and Gina Misagal.