Manila arrests owner of clinic in alleged fake dialysis scam

WellMed, a dialysis clinic based in Quezon City, north of Manila, had exploited a loophole in PhilHealth's claims and payments system.
WellMed, a dialysis clinic based in Quezon City, north of Manila, had exploited a loophole in PhilHealth's claims and payments system.PHOTO: WELLMED DIALYSIS/FACEBOOK

Philippine government agents yesterday arrested one of the owners of a healthcare service provider involved in a purported scam that cheated the state-run health insurer by submitting fake dialysis claims.

This came soon after President Rodrigo Duterte instructed the head as well as board of the Philippine Health Insurance Corp (PhilHealth), the state insurer, to hand in their resignation.

Dr Brian Sy, an ophthalmologist who is listed as one of the owners of WellMed Dialysis & Laboratory Centre Corp, was held after he went to the main office of the National Bureau of Investigation (NBI) in Manila.

Mr Duterte had said the losses from the "ghost dialysis" scam were "totally, totally unacceptable", and that those behind it should be prosecuted.

"Arrest the idiot," Mr Duterte said in an interview last Saturday on the television programme of an ally. Mr Duterte also said he wanted Dr Sy brought to him. "I will ask him, 'Tell me the truth, and I will throw you to the river'. But he will be extricated. We will not allow him to be drowned," he said.

Dr Sy was held for fraud, though an NBI official said a case had yet to be filed against him.

WellMed - a dialysis clinic based in Quezon City, north of Manila - had exploited a loophole in PhilHealth's claims and payments system, the Philippine Daily Inquirer reported in a series of stories from last Thursday, citing a former employee of the clinic.

 

The loophole had allowed WellMed to receive payments for the fictitious dialysis treatment of dead patients since 2016, the Inquirer reported.

The clinic also allegedly padded its claims by seeking payments for treatments that patients were entitled to but no longer had any need for, and therefore did not use.

PhilHealth apparently lacks a mechanism to check on its own if a member is already dead or still receiving treatments. In nearly all cases, it relies on hospitals and clinics like WellMed.

Lawyers from WellMed denied the allegation and countered that the fraud was perpetrated by the accuser, in connivance with another employee.

The Inquirer reported that the dialysis scam was just one of thousands of cases involving fictitious claims and abuse that had cost PhilHealth at least 100 billion pesos (S$2.7 billion) since 2013.

These included cases where cases of coughs or colds had been filed as pneumonia, and claims were sent to PhilHealth.

Ms Shirley Domingo, a PhilHealth spokesman, said it had been investigating cases of fictitious or bloated claims.

The state insurer had 8,925 pending cases against clinics and doctors, she disclosed.

A version of this article appeared in the print edition of The Straits Times on June 11, 2019, with the headline 'Manila arrests owner of clinic in alleged fake dialysis scam'. Print Edition | Subscribe