The National Bureau of Investigation (NBI 7) is set to file anytime next week the first batch of cases it investigated in connection with the questionable claims of some private hospitals from the regional office of the Philippine Health Insurance Corp. (PhilHealth) 7.
In an interview with GMA 7 regional TV Balitang Bisdak correspondent Alan Domingo, NBI 7 Director Renan Oliva said they already completed the first batch of cases they investigated and it would be filed next week. Oliva said it took them several months to investigate the anomalies because they needed to secure documentary evidence and testimonies from several persons who had knowledge of the anomalies to support their cases in court. These will be filed before the Office of the Visayas Ombudsman as these involve graft and corruption.
Oliva refused to reveal the personalities and hospital institutions they would be charging but he said the anomalies are not only committed by one or two persons. “It’s a collusion and a conspiracy,” he said. Meaning, it’s a group of persons from the state insurer corporation, hospital officials, doctors and some patients who agreed to be used by those responsible just to claim funds from PhilHealth.
Oliva said suspected Covid-19 patients who were admitted in some private hospitals were swabbed or tested for Covid-19. Even though some of them were found negative, they were marked down as positive on hospital records so they could avail themselves of PhilHealth’s financial coverage for confirmed Covid-19 patients. Oliva clarified that some patients had no knowledge of the conspiracy. The money they claimed were then divided by personalities behind or those responsible for the release of the fraudulent claims.
Sometime in March this year during the surge of Covid-19 cases, PhilHealth released an advisory which stated: “In the midst of growing public concern over the financial costs of getting treatment for Covid-19, the Philippine Health Insurance Corporation (PhilHealth) once again assured the public that it will ‘shoulder the full cost of treatment of Covid cases until April 14, 2020’.”
In a subsequent advisory addressed to all accredited hospitals and health facilities in the country, PhilHealth clarified that “after the (said) date, we shall continue to provide financial coverage to Covid cases through a recomputed case rate, citing that the reason for this accommodation window is due to the novelty and the wide range of severity of the disease in the country for which no existing case rate or package based on accepted protocols has yet been established.”
Patients confined as probable or confirmed cases can avail themselves of benefits packages as follows: a P43,997 package for patients with mild pneumonia confined in Level 1 to 3 hospitals; a P143,267 package for those with moderate pneumonia in Level 1 to 3 hospitals; a P333,519 package for severe pneumonia confined in Level 2 to 3 hospitals, including ICUs; and a P786,348 package for patients with critical pneumonia confined in Level 2 to 3 hospitals, including ICUs.
These packages cover the rates for a private hospital room, management and monitoring of illness, laboratory diagnostics and imaging, medicines included in the guidelines and protocols of the Department of Health (DOH) and supplies and equipment, including PPEs.
You can just imagine the amount pocketed by PhilHealth officials, hospital officials, doctors and perhaps patients involved in these anomalies. That was probably one of the reasons Covid-19 cases went up and some of the private hospitals were overwhelmed by Covid-19 patients.
After the PhilHealth financial coverage was amended following the discovery of these anomalies, some private hospitals were no longer overwhelmed by Covid-19 patients and the daily case monitoring rate drastically went down.