Philippine agents arrest owner of clinic in alleged fake dialysis claims

  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

MANILA -Philippines government agents on Monday (June 10) arrested one of the owners of a healthcare service provider involved in a purported scam to bilk the state-run health insurer with fake dialysis claims.

This comes as President Rodrigo Duterte instructed the president and board of the Philippine Health Insurance Corp (PhilHealth), the state insurer, to hand in their resignation.

Dr Brian Sy, an ophthalmologist and 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.

His arrest was made two days after Mr Duterte 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 on Saturday (June 8) on the television programme of an ally.

Mr Duterte said he wanted Mr 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.

Mr 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, quoting an accusation by a former employee of the clinic.

The loophole 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$2.6 billion) since 2013.

These included cases where coughing or a cold was filed as pneumonia, and claims were sent to PhilHealth.

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

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

PhilHealth also had "robust finances", posting last year a net income of 11 billion pesos and a benefit payout of 120 billion pesos, she added.

Mr Duterte on Saturday (June 8) sought to sack PhilHealth's entire management, and introduce new accounting and management systems that will provide the insurer with checks and balances to detect and prevent fraudulent medical claims.

In a news briefing on Monday (June 10), Senator-elect Bong Go, Mr Duterte's former aide, disclosed that Mr Duterte had already asked PhilHealth president Roy Ferrer and his entire board to step down.

Mr Duterte said on Saturday (June 8) he did not have the "slightest doubt about the integrity and honesty" of Dr Ferrer, one of his personal doctors.

Mr Go said Mr Duterte still believes that Dr Ferrer was "very honest".

"But his men ran rings around him. It's command responsibility," he said.