Sep 23, 2021 @ 9:57

Just in: NBI files complaints vs hospital execs over fraudulent PhilHealth claims

The National Bureau of Investigation (NBI) has recommended the filing of criminal charges against seven (7) officers and staff of Tricity Medical Center in Pasig City for fraudulent claims from Philippine Health Insurance Corporation (PhilHealth) before the Department of Justice.

NBI-Officer-In-Charge (OIC) Director Eric B. Distor identified the suspects as Enrico C. Cruz, M. D., Hospital Administrator and a Member of the Board of Directors of Tricity Medical Center; Dr. GJay Lalu Ordinal, Dr. Froilan Antonio de Leon, and Dr. Lourdes Rhoda Reyes Padilla, all of whom are doctors of Tricity Medical Center.

Cherry Catalan Flores, R. N. of the hospital, Arlene Joy Sebuc, Philhealth Staff of Tricity Medical Center, and Svend Agodilos Rances, hospital clerk.

The complaint against them stemmed from an intelligence information received by the NBI-Anti Graft Division (NBI-AGD), alleging that Tricity has been fraudulently facilitating or claiming reimbursement from PhilHealth for hemodialysis patients which turned out to be non-existent or already deceased at the time of the supposed hemodialysis treatment.

The NBI-AGD conducted an investigation to determine the truthfulness of the information and to arrest those who are responsible for the fraudulent claims.

Thorough investigation conducted by the NBI-AGD, it was revealed that there was at least 318 Fraudulent Claims with a total amount of Php 824,200.00 filed by Tricity based on recorded dates of hemodialysis treatment after the death of patients.

NBI-AGD also revealed that the fraudulent claims could be higher based on the 2016 to 2019 Philhealth database which showed a total of Php 4,308,000.00 involving the above-mentioned patients.

On September 20, 2021, the NBI-AGD recommended the filing of charges against the suspects before the DOJ for estafa defined and penalized under Article 315 (2) of the Revised Penal Code (RPC, as amended; and violation of Section 44 of R.A. 7875, otherwise known as the “National Health Insurance Act of 2013, as amended by Republic No. 9241 and R.A. 10606.

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