Wednesday, October 03, 2007 7 docs, hospital under probe over cataract anomaly By Erwin Ambo S. Delilan
SEVERAL doctors and hospitals in Western Visayas are being mentioned in the investigation on the alleged massive fraudulent collection of Philippine Health Insurance (PhilHealth) claims through cataract operations.
Lawyer Jay Villegas, head of PhilHealth’s fact-finding investigation section, said the "red flag" is up on hospitals and doctors doing cataract cases in Western Visayas.
In Bacolod, there are seven doctors now being investigated but only three were named for having allegedly made millions in PhilHealth insurance claims.
These are Nonito Avecilla, Miguel Sarabia, and Leopoldo Cuaycong, all top eye specialists at the Bacolod Our Lady Mercy Specialty Hospital (BOLMSH) in Eroreco, Barangay Mandalagan, Bacolod City.
According to PhilHealth in Region 6, the three conduct cataract operations chargeable to PhilHealth insurance.
Most of their patients are barrio residents who are members of PhilHealth, the PhilHealth Region 6 report added.
Based on the findings of the team sent by PhilHealth to Bacolod City, Sarabia, Cuaycong and Avecilla are being charged by some of their patients with alleged misrepresentation.
In the case of Sarabia, according to PhilHealth, there were about five patients who said they were not informed by the doctor that his services to them will be charged to their PhilHealth insurance.
Sun.Star contacted Sarabia but he refused to say anything on the issue except: "All stories implicating my name, Cuaycong, Avecilla and BOLMSH are just insinuations...Until now, no formal charges have been filed against any doctor or hospital."
On the claim of misrepresentation, he said "this is just a sort of misunderstanding between him and his patients."
Sarabia though said he's ready to defend himself on this matter.
Sarabia, a US-trained ophthalmologist with over 20 years in experience, is now handling the Barangay Eye Program of Bacolod City under the Leonardia administration.
Cuaycong and Avecilla can't be reached for comment as of Tuesday night.
Medical cancer
In her previous statement, PhilHealth Vice President Madeleine Valera said dubious claims on PhilHealth insurance has reached almost P4 billion and labeled it as a "medical cancer, medical malady, and a systemic disease."
Valera said the "culprits" appear to be a number of doctors who are acting in cahoots with "runners" and "agents" victimizing poor patients suffering from eye illnesses.
This is now alarming, warned Valera, saying that Philhealth is now on the verge of bankruptcy.
PhilHealth Region 6 Officer-in-Charge Alberto Mandurriao cited Negros Occidental as the area in Western Visayas with a huge increase in cataract-case claims last year and early this year.
Mandurriao then called the scenario "unusual" and said an investigation is now underway to validate and verify the numerous claims.
He said that based on their investigation, claims appear to be legitimate and within the guidelines set by PhilHealth.
But what raises suspicions and doubts, he said, are the manner of the recruitment and enlistment of PhilHealth members.
PhilHealth is a government corporation that ensures sustainable, affordable, and progressive social health insurance that endeavors to influence the delivery of accessible quality health care to all Filipinos.
It pushes for a universal medical coverage while ensuring better benefits to members and their beneficiaries at affordable premiums.
