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There is no basis
for the city government to collect P1.5-million in damages
and refund for fraudulent claims charged by the Medical Mission
Group Hospital and Health Services Cooperative (Coop Hospital)
to the Blue Card program.
This
was the claim made by Coop Hospital board chair Dr. Grace
Araneta in an exclusive interview over dyRD's "Inyong
Alagad".
She
said that based on the findings of its external auditors,
only four Blue Card patients' claims were found overstated.
Of
the four patients, only one transaction was actually consummated,
Araneta claimed.
Since the issuance of its Blue Card accreditation in September
2006,
Coop
Hospital has already accepted 290 Blue Card patients.
According
to Araneta, Coop Hospital has withheld further reimbursements
made on the Blue Card since the reported padding of claims
last July.
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Araneta
revealed that the audit conducted by City Hall on Blue
Card transactions at Coop
Hospital was not done with due diligence.
Based
on the investigative report of the task force created
by City Mayor Dan Lim, it only showed one particular
transaction instead of conducting a comprehensive examination
of hospital records pertaining to Blue Card claims,
Araneta said.
Moreover,
Coop Hospital billings to the city government only amounted
to P200,000.
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'STEWARDSHIP'
Araneta,
who also testified during two hearings of the Sangguniang
Panlungsod committee on public accountabilities, stressed
that the Coop Hospital management is aware that the Blue Card
program has to be managed well as it involves public funds
which benefits indigents.
"This
is a matter of stewardship for us," she said.
According
to Araneta, when she discovered the flaws of the program through
a falsified claim made by one Anastacia Bertumen on July 25,
she immediately consulted with hospital director Dr. Jalad
and the hospital's ethics committee head, Atty. Eliseo Labaria.
They
informed the city mayor the following day regarding the incident,
however, Araneta said City Hall did not act on the matter
until a month after when Bertumen complained in a letter addressed
to the mayor.
The
complaint alleged that Coop Hospital management used Bertumen's
Blue Card for padding of claims.
However,
during that time, Bertumen and four other hospital employees
were already placed on preventive suspension, Araneta said.
Araneta
admitted there are flaws on the part of the hospital regarding
its implementation of the program.
Bertumen,
an employee of the hospital, was never confined but was able
to secure a referral from Blue Card administrator Dr. Antonio
Porticos, Araneta said.
A
patient's referral is necessary to claim for Blue Card reimbursements.
Bertumen
accordingly went personally to Porticos to get the referral
to prove that she was admitted, when in fact, according to
Araneta, she (Bertumen) had an accountability to Coop Hospital
for her medicines in the amount of P900.
She
made the claim for reimbursement on the Blue Card to settle
the obligation, Araneta explained.
Expenses
for medicine can only be charged to the Blue Card when the
patient is admitted.
Araneta
bared that Porticos was aware that Bertumen was not confined
(as stated in the latter's affidavit) but went on to issue
the referral.
The
fraud was committed in connivance with the hospital's billing
clerks.
The
city government paid P52,000 for Bertumen's claim. However,
this was withheld by the hospital management after they were
already aware of the irregularity.
Charges
have been filed against Bertumen and four hospital personnel
involved in the false claims, said Araneta.
SP
INQUIRY
Operational
lapses of the Blue Card implementation were uncovered during
the SP hearings.
SP
committee on public accountabilities chair Kag. Anne Mariquit
Oppus said the committee's findings is still being consolidated.
During
the hearing, it was learned from Porticos that he is virtually
running the Blue Card program by himself.
It
was admitted by Porticos that "the program is abused
by its beneficiaries" that supposedly belongs to the
city's indigents.
Among
several weaknesses discovered is the absence of referrals
from the Blue Card office before patients are admitted to
the hospital.
Normally,
according to Porticos patients who are covered under the program
are examined beforehand at the Blue Card office.
Many
patients do not adhere to this system, Porticos bared, since
most beneficiaries are admitted first before they find out
that they could avail of the free hospitalization.
Likewise,
in emergency cases the system do not apply, he said.
Araneta
revealed that about 80% of patients admitted at the Coop Hospital
comply with the referral requirement only upon confinement.
Some
Blue Card beneficiaries even accomplish their requirements
when they are discharging from the hospital. (with reports
from Chito Visarra)
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