NBI-Dagupan files raps vs 24 PhilHealth execs, 18 hospitals

By September 5, 2021Headlines


AT the instance of the Department of Justice, the National Bureau of Investigation (NBI) District Office in Dagupan City filed complaints at the Office of Ombudsman in Quezon City on September 1 against 15 identified officials of PhilHealth  in main office and  five in Region 1 office in Dagupan City, and 18 hospital owners or directors in Region1 for alleged misuse of the Interim Reimbursement Mechanism (IRM) intended for COVID-19 cases.

Four John/Jane Does occupying  sensitive positions were listed as well.

Nine hospitals in Pangasinan were listed in the complaint.

On March 31, 2020, The PhilHealth Board appropriated P27,022,668,580 and P782,476,917 were released as claims at the time of the investigation.

In the copy of the complaint provided The PUNCH, the hospitals named in the complaint were: Candon St. Martin De Pores Hospital (Ilocos Sur), City of Candon Hospital (Ilocos Sur), Del Carmen Medical Clinic and Hospital (Pangasinan), Divine Mercy Foundation of Urdaneta Hospital (Pangasinan), El Corazon De Jesus Medical and Diagnostic Clinic (Pangasinan), Gaoat General Hospital (Ilocos Norte), Ilocos Sur District Hospital-Masingal (Ilocos Sur), Jesus Nazarene General Hospital (Pangasinan), Judge Celestino Guerrero Memorial Hospital (Ilocos Sur), La Union Medical Center (La Union) , Lorma Medical Center Inc.  (La Union), Mariano Marcos Memorial Hospital (Ilocos Norte)  Pangasinan Doctors Hospital (Pangasinan), Pira Hospital (Ilocos Sur),  Sta. Teresita Hospital (Ilocos Norte), Sto. Cristo Milagroso Hospital (Ilocos Sur), Sto. Niño Hospital  (Pangasinan), and Tayug Family Hospital (Pangasinan).

Earlier on August 4, similarly charged for the same complaint were Corpuz Clinic Hospital (Ilocos Sur), Socony Medical Group (Pangasinan), Bacarra Medical Center (Ilocos Norte) and Elguira General Hospital (Pangasinan).

Charged among the PhilHealth respondents are Ricardo Morales, former President and CEO; Augustus de Villa, former Senior Vice President; Arnel De Jesus, Executive Vice President/COO; Nerissa Santiago, Acting Senior Vice President; Renato Limsiaco Jr., Senior Vice President; Israel Francis Pargas, former Senior Vice President; Rodolfo del Rosario Jr. chief of Legal Sector; Dennis Mas, Chief, Management Services Sector;

Walter Bacareza, Area Head of Area 3; Oscar Abadu Jr., former Vice President; Alfredo Pineda II, Area Vice President for Area 1; Emily Roque, Senior Vice President of Fund Management; Calixto Gabuya Jr., former Senior Manager ICT & Management; Rene Pascua, Project Management Team (Claims, Health finance); Jonathan Michael Ele, Head of Project Management Team ; John/Jane Does, designated Adjudicator;

Alberto Manduriao, former Regional Vice President; Maricar Arzadon, Chief of Health Care delivery Management Division; Jane Ragos, Head of Fund Management of PRO1; Jose Mones, Budget Officer of PRO1; Marife Arenas, Senior Social Insurance Officer of PR01;

John/Jane Does (3), Medical Evaluator, Claims Processing chief, Designated Adjudicator.

In an interview last Thursday, NBI Dagupan District Office Agent-In-Charge Rizaldy Jaymalin, who signed the complaint, said Secretary of Justice Menardo Guevarra and NBI Officer-In-Charge Eric Distor had ordered a thorough investigation on the allegations of widespread corruption and anomalies in PhilHealth, and alleged irregularities in utilization of the IRM fund by PhilHealth Regional Office 1 (PRO1) and received by 49 HCIs.

Jaymalin explained that IRM is a fund mechanism provided by the government purposely for COVID cases where the Health Care Institutes (HCI) can avail of an advance fund from PhilHealth.

The rampant misuse was traced to practices of the hospitals to avail of the IRM using invalid claims, particularly for non-COVID-19 patients.

The IRM scheme was also made available during the Marawi siege so that hospitals can cope with the big number of patients, and in the Visayas when there was a calamity.

Jaymalin said Secretary of Justice and NBI Officer-In-Charge Eric Distor had ordered a thorough investigation on the allegations of widespread corruption and anomalies in PhilHealth, and alleged irregularities in utilization of the IRM fund by PhilHealth Regional Office 1 (PRO1) and received by 49 HCIs.

The Ombudsman complaint stemmed from reported abuses of the Circular 2020-007 dated  March 20, 2020 and signed by BGen. Ricardo Morales, then President and CEO of PhilHealth, providing for the guidelines on the provisions of special privileges to HCIs affected by fortuitous events.

The complaint said P27, 022, 668, 580.81 was appropriated for IRM funds to address the adverse effects of COVID -19 pandemic and out of which P782, 476, 917.41 was released to HCIs in PhilHealth Region 1.

The complaint cited the disbursed funds that were released in the form of cash advances, which is contrary to Commission on Audit rules since cash advances do not have enough security features to ensure safeguard of funds and proper audit.

Secondly, the questioned cash advances given to the HCIs were made prior to the required publication and submission of three certified true copies of PhilHealth Circular No. 2020-0007 to the Office of the National Administrative Registrar, an essential requirement for the resolution to become operative, thus rendering all prior releases unauthorized.

Thirdly, funds specifically for COVID-19 cases were utilized for non-COVID cases and for cases other than the intended purpose.

Fourth, there were HCIs not qualified but were given unwarranted access to IRM, like dialysis centers.

The complaint specifically cited “PhilHealth officials who have the authority to approve and implement the IRM fund and released it to select HCIs are in conspiracy to make the release of IRM fund to certain HCIs possible.”

Complaints filed were for Violation of Section 44 of Republic Act 10606, otherwise known as National Health Insurance Act and technical malversation (Art. 220 of the Revised Penal Code), violation of Section 3 (e) (g) and (j) of Republic Act No. 3019 otherwise known as Anti-Graft and Corrupt Practices Act and administrative cases of Grave Misconduct, Gross Dishonesty, Gross Negligence and Conduct Prejudicial to the Best Interest of Service.

The NBI did not say whether any of the named hospitals refuted the findings during the investigation. (Eva Visperas)

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