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Doctors
and hospitals here involved in supposedly free medical missions
but filed reimbursement claims at the Philippine Health Insurance
Corporation (PhilHealth) are now the target of an investigation.
This
was bared to the Chronicle by PhilHealth fact-finding and
administrative investigation chief Atty. Jay Villegas in an
interview yesterday.
Reports
of frequent medical missions here have alarmed PhilHealth
officials after finding out that claims were made against
the health insurance firm while patients were made to believe
their treatments were for free.
According
to Villegas, they will be filing charges against these doctors
and hospitals for unethical practices and grave abuse of medical
authority.
A
team from PhilHealth's task force "Kisapmata" will
be sent here, according to Villegas.
The so-called medical missions also put the lives of patients
in great risk, Villegas said, as doctors perform multiple
medical procedures involving hundreds of patients that would
instead "infect rather than cure" the patients.
THE
SCAM
At
least two beneficiaries of a medical mission last March carried
out by the provincial government through the Philippine Charity
Sweepstakes Office revealed to the Chronicle that they were
unwittingly made accessory to spurious claims made on their
respective PhilHealth accounts.
Julia
Adorable, 69, a resident of barangay Jimili-an, Loboc town
and Leoncio Malig-on, 75, a resident of Poblacion Loboc town
were both surprised and confused when they received a "Benefit
Payment Notice" from the PhilHealth regional office.
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The
notice was for their cataract operation on March 26,
2007 at the Gov. Celestino Gallares Regional Hospital
(GCGRH).
Their
statements of Benefit Payment Notice showed Adorable
and Malig-on were each charged professional fees of
P7,200 for the cataract extraction and P3,490 for the
GCGRH operating room expenses.
According
to Adorable and Malig-on, they were led to believe that
their cataract extraction was for free during the medical
mission conducted here.
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A
cataract operation will normally cost P50,000 for one eye
with the replacement lens costing P30,000.
Both
Adorable and Malig-on claimed they never filed reimbursement
claims with PhilHealth for their cataract operations.
However,
they recalled filling up what they thought as "information
sheets."
They
were allegedly told data was needed for a post operation survey
conducted for the cataract operations. Their PhilHealth membership
personal identification numbers (PIN) were required in the
"information sheets".
In
a separate interview with the Chronicle, a staff from the
GCGRH PhilHealth section revealed that she received orders
from "top management" of the hospital to assist
personnel from the office of the consultant on health and
social services to facilitate the processing of purported
claims for PhilHealth refunds of cataract extraction operations
in the hospital.
Dr.
Nenita Po, GCGRH chief, could not be contacted for comments
until presstime.
Information sheets taken from the patients during the province-wide
"survey" were used as supporting documents for the
claims, according to the source.
The
Benefit Payment Notice of Adorable and Malig-on showed that
the total amount of hospital charges and professional fees
under "Actual Charges" were not deducted from the
medical benefit of the member.
The
recent medical mission here was being trumpeted as "the
biggest free surgical-medical mission" in the history
of the Philippines.
The
medical mission involved a seven-man team of top ophthalmologists
headed by Dr. Malubay who is chairman of the Philippine Association
of Medical Surgeons (PAMS) Outreach Program.
The
medical group performed 1,603 cataract operations, performing
a 10-minute Microvascular eye procedure pioneered by Dr. Malubay.
They
also conducted eye check-ups, treatment and distributed medicines
to some 5,300 indigent patients from all over the province
from March 24 to April 4, 2007.
The
12-day medical mission, jointly sponsored by the Philippine
Charity Sweepstakes Office, also covered major operations
for goiter, clubfoot, myoma and hernia.
According
to press statements issued by proponents, "the biggest
free medical mission" in the history of the Philippines
cost P80 million.
'UNETHICAL
PRACTICE'
Villegas
said PhilHealth has created task force "Kisapmata"
to investigate the abuses of doctors and hospitals through
bogus claims.
Aside
from terminating PhilHealth accreditation, doctors and hospitals
could face criminal suit, said Villegas.
PhilHealth
figures show that the health insurance firm is paying an average
of P18,000 in reimbursements for cataract extractions.
'NOT
ILLEGAL'
Meanwhile,
Fancy S. Baluyot, Provincial Consultant on Health and Social
Services said in an exclusive interview with the Chronicle
that doctors performing cataract extraction are allowed by
PhilHealth to charge professional fees, whether during a medical
mission or not.
"This
is not illegal. PhilHealth has not specified that doctors
could not charge professional fees [for cataract operations].
What is illegal is charging PhilHealth for non-existing operations"
Baluyot explained.
Baluyot
admitted that "out of gratitude and pity" to the
top-rated opthalmologists and the operating room personnel
assisting in the operations, around sixty cataract patients
offered to charge it to their PhilHealth accounts.
Dr.
Malubay and his team knew that their operations were charged
to PhilHealth.
However,
some PhilHealth members may not be aware of these arrangements,
added Baluyot.
Another
Medical Mission for cataract patients is scheduled for Bohol
this December, according to Baluyot.
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