PhilHealth scam: Eye doctors deny fraud allegations
MANILA, Philippines – Two eye doctors from the Pacific Eye Institute have denied the fraud allegations hurled at them by the Philippine Health Insurance Corporation (PhilHealth).
Dr Christopher Barasi and Dr Bryan Bernard Ong Kian Koc made the denial at the 2nd Senate blue ribbon committee hearing on questionable PhilHealth claims on Wednesday, July 8.
PhilHealth is investigating top 10 ambulatory surgical centers – including Pacific Eye – claiming for cataract procedures after it discovered a "very conspicuous rise" in claims which also coincided with complaints from patients.
Their audit findings revealed that Barasi performed a cataract surgery on a patient despite his suspended PhilHealth accreditation. His co-surgeon, Ong, was the one who signed the claim forms.
During the Senate hearing, Pacific Eye owner Dr David Gosiengfiao claimed that PhilHealth gave Barasi permission to operate as long as he was co-managed by Ong.
PhilHealth president Alex Padilla denied the claim, prompting Gosiengfiao to admit that the permission was given through "verbal communication."
But regardless if Barasi had permission or not, Senator Teofisto Guingona III said the patient's affidavit gave no indication that Pacific Eye had informed her of the status of Barasi's PhilHealth accreditation.
The patient also claimed that Ong was not in the operating room when Barasi performed the cataract procedure – an allegation that the latter "strongly denied."
"There was never any time I do surgery without [Ong]," Barasi told senators.
But Guingona shot back: "There are some affidavits here and your name keeps popping up. There's a saying: When there's smoke, there's fire."
P40 million in 2 years?
Ong was also grilled by senators for allegedly performing up to 3,023 operations in just two years as a PhilHealth-accredited doctor. According to PhilHealth, his claims amounted to around P39 million ($862,660.46):
- Pacific Eye Institute-Makati - P36 million ($796,144.34)
- Pacific Eye Institute-Laguna - P2.4 million ($53,076.29)
- Chinese General Hospital - P700,000 ($15,480.58)
- Eye Wellness Correction Center - P129,000 ($2,852.85)
- Manila Adventist Medical Center - P13,000 ($287.497)
"For such a young doctor, you certainly are very prolific," Guingona told Ong.
Ong denied any affiliations with Manila Adventist Medical Center. He also corrected PhilHealth's figures.
Citing his census, Ong said from November 2013 to May 2015, "we've done 2,727 cases, [and] some of these cases I've personally done."
"If Dr Barasi is correct with 2,727 operations in 19 months, that would total to 144 [operations per month]," Padilla pointed out.
But Barasi said this is not "statistically impossible."
"All of the ophthalmologist here would know that not all of these are very difficult or time-consuming surgeries. If you're efficient enough, especially if you're co-managing, it amounts to around 10 to 15 minutes per eye. The lasers, [we] can do it in a span of 5 to 7 minutes," he explained.
In fact, from March 2014 to December 2014, the two did 705 cataract surgeries, which translates to 70.5 surgeries a month, 17.6 a week, and 3 a day.
But since PhilHealth started its probe into the "scam," it has already limited to 50 patients per month the number of cataract surgeries a doctor can claim with PhilHealth.
Removal of cataracts ranked 4th among the top conditions and procedures PhilHealth paid for in 2014. This is equivalent to P3.7 billion ($81.70 million) out of the P78-billion ($1.72 billion) total benefit payments that year. – Rappler.com
*US$1 = P45.29
Hand holding glasses images via Shutterstock