Highlights
- Co-owner of WellMed Dialysis Center in Manila arrested amidst charges of "ghost" kidney treatments
- Case involves allegedly sham dialysis procedures on dead patients that were later charged to PhilHealth, a state-owned health insurer
- Value of allegedly fraudulent claims unclear
- Arrest made based on complaints from PhilHealth and whistleblowers
MANILA, Philippines: Fraudulent health insurance claims for suspected "ghost" kidney treatments have led to at least one arrest here.
Authorities placed Bryan Sy, a Filipino citizen and co-owner of WellMed Dialysis Center in Novaliches, a suburb of Manila, under arrest on Monday.
Four doctors were separately charged for allegedly non-existent dialysis treatments that taxpayers ended up paying for.
The National Bureau of Investigation (NBI) has tagged Sy in allegedly sham claims for kidney treatments of already dead people that were later charged to the Philippine Health Insurance Corp. (PhilHealth).
Complaints
Philippine media quoted Nick Suarez, spokesperson of NBI, as saying that Sy is already under arrest on the basis of the complaints filed by PhilHealth and WellMed whistleblowers.
The amount paid by PhilHealth, an agency partly funded by Filipino tax-payers, for allegedly "ghost" treatments was not immediately clear.
But on Saturday, President Rodrigo Duterte said he would "reorganise" PhilHealth after it was reported that the agency lost Php154 billion ($2.95 billion) to "ghost" patients and deliveries, Philippine media reported.
Update as of Monday, 6pm (Manila time): With reports of other fraudulent PhilHealth claims emerging, Duterte had asked the top brass of the state-owned health insurer to "resign", according to Senator-elect Bong Go, a close aide of Duterte.
Go, a former special assistant to the president who later won a Senate seat, is now set to head the chamber's Health Committee. Go was quoted by ABS-CBN news channel that Duterte relayed the instruction to PhilHealth officials through him.
Earlier, Sy and his lawyer, Rowell Ilagan, submitted themselves to NBI following a subpoena sent by the bureau.
Menardo Guevarra, President Rodrigo Duterte's Justice Secretary, disclosed receiving information that Sy “has been held and will be brought for inquest proceedings immediately.”
“They submitted themselves to NBI based on the subpoena issued to them,” Suarez was quoted by the Inquirer as saying.
Suarez added, however, that PhilHealth officials as well as the whistleblowers from WellMed later arrived and submitted their complaints.
Based on the documents submitted by PhilHealth and the whistleblowers, the NBI “has found sufficient basis to effect the arrest.”
“Not until the inquest is completed, at least,” Sy cannot leave the NBI premises, Justice Secretary Guevarra said.
What health official says
WellMed Dialysis Center earlier said the company would file charges against two employees for alleged conspiracy to file fees for dialysis treatment for dead patients between 2016 and 2018.
The said workers were the same people who reported the scam to PhilHealth last year, and relayed the scheme to the Inquirer earlier this week.
Health spokesperson Dr. Rolando Enrique "Eric" Domingo, spokesperson of the Department of Health, said local TV programme ANC
"I don't think there would be motivation for them to file fraudulent cases. If they were nurses and they file the claims, the money would not go to them, it will go to the hospital," he said.
"Every time Philhealth reimburses, it goes directly to the hospital," he said.
What is PhilHealth
The Philippine Health Insurance Corp. (PhilHealth), a government owned and controlled corporation (GOCC), was created in 1995 to implement universal health coverage in the Philippines.
It is a tax-exempt entity attached to the Department of Health.
Its main goal is to ensure the health of every Filipino through social health insurance regardless of social status: poor, rich, young, old, sick, healthy, working or jobless.
To achieve this, all premiums paid by members are pooled nationally and in effect, there is a cross-subsidization across districts.
