PhilHealth probes P6M ‘ghost claims’ in Tuguegarao hospital

TUGUEGARAO CITY, Philippines – Authorities are looking into P6 million ($119,500) in reported ghost claims to PhilHealth benefits, almost P4 million ($79,700) higher than the initial data the Tuguegarao city government discovered in January. 

In an interview with a local radio station, acting Vice Mayor Jude Bayona said more irregularities have been uncovered from their own investigation of the alleged anomalous transactions inside the city-funded Tuguegarao City People’s General Hospital (TCPGH).

Bayona said the irregularities started as early as 2013 and continued up to the early part of 2017.

“It could amount to P6 million by now,” Bayona said.

He also said the investigation showed that the doctor allegedly involved in the scam charged a consultation fee of P21,000 to P42,000 ($418 to $836) per ghost patient.

Bayona did not name the doctor but a copy of the result of the initial investigation obtained by Rappler showed that Dr Christopher Ian Cabalza, a private practitioner and a visiting physician at TCPGH, had signed most of the alleged anomalous claim eligibility forms.

In a phone interview on Saturday, March 25, PhilHealth regional director Oscar Abadu Jr said they have yet to “fully validate” the whole amount involved in the scam.

Abadu said they will still conduct further investigations and home visits to the alleged ghost patients.

Earlier, TCPGH administrator Dr Ray Dulig told Rappler a certain Marites Attaban, a casual hospital employee, “connived” with a visiting physician to process the ghost claims.

Damage payment

Acting Mayor Benben De Guzman said the city government will be forced to pay PhilHealth whatever amount is involved.

After a city council hearing on the issue, on Wednesday, March 22, De Guzman said he will look into the possibility of including the amount, allegedly between P2 million to P6 million ($39,800 to $119,500), in the supplemental budget.

He added that the move is for the health agency to reaccredit the hospital.

After discovering the scam, Abadu said they decided to deny TCPGH accreditation to host PhilHealth members.

In an advisory, Abadu said they have denied TCPGH application “due to lawful and justifiable grounds.”

“Henceforth, all PhilHealth claims covering confinements beginning January 1, 2017, filed by or in behalf of TCPGH, shall be declined for processing until such time the accreditation of TCPGH will be renewed,” Abadu said.

The city government has submitted an appeal to PhilHealth as soon as the suspension came, Abadu confirmed.

Affected PhilHealth members have stopped trooping to the TCPGH for consultation and treatment after the former suspended the accreditation of the hospital in February.

To remedy the situation, De Guzman said a resolution was submitted to the 7th City Council to allow affected members to write promissory notes for their consultations and treatment at the “hospital in crisis” pending investigation so as not to affect the health of patients.

The City Council rejected the resolution. – Rappler.com

*$1 = P50.18