PhilHealth-7 denies NBI-7’s allegations of corruption

By: Mae Fhel Gom-os - CDN Digital Multi-Media Reporter | July 02,2021 - 03:20 PM


Lawyer Rennan Augustus Oliva, NBI-CEVRO director. | CDND Photo by Alven Marie A. Timtim

CEBU CITY, Philippines — The PhilHealth Regional Office in Central Visayas has denied allegations of corruption hurled by the National Bureau of Investigation (NBI-7) for its approval and release of reimbursement to a Cebu City hospital even if there were attached documents showing two negative COVID-19 test results of a patient who died in May last year.

In the statement released on Friday afternoon, July 2, 2021, the government-owned insurance company said they continue to abide by the guidelines in processing claim documents.

“In view of the recent allegations of NBI-7, PhilHealth Regional Office VII sticks to its previous statement that it continues to abide by the guidelines in processing claim documents per published circulars which are developed by its policy-making sector and are approved by the PhilHealth Board,” read part of the statement.

They said their basis in processing claims was the PhilHealth Circular 2020-0009 entitled “Benefit packages for inpatient care of probable and confirmed COVID-19 developing severe illness/outcomes,” which was published on April 14 last year.

Under the said circular, terms such as suspect case, probable case, and confirmed case of COVID-19 are defined.

A suspect case is defined as a person who is presenting any of the following conditions: all severe acute respiratory infection (SARI) cases where no other etiology fully explains the clinical presentation; influenza-like illness (ILI) with either no other etiology that fully explains the clinical presentation and a history of travel to or residence in an area that reported local transmission of COVID-19 disease during the 14-day prior symptom onset or with no contact to a confirmed or probable case of COVID-19 disease during the 14 days prior to the onset of the pandemic; individuals with fever or cough or shortness of breath or respiratory signs or symptoms aged 60 years and above or with comorbidity.

Meanwhile, a probable case is a suspect case that fulfills any of the following: suspect case whom laboratory testing for COVID-19 is inconclusive; suspect who underwent testing for COVID-19 but not conducted in a national or subnational reference laboratory or officially accredited laboratory for COVID-19 confirmatory testing; and suspect case for which testing could not be performed by any reason.

NBI-7 filed Anti-graft and Corrupt Practices Act and Malversation of Public Funds or Property charges against eight PhilHealth-7 officials and six hospital officials before the Office of the Ombudsman Visayas for allegedly upcasing the cause of death of a patient into COVID-19.

NBI-7  Director Rennan Oliva said the patient, who was a retired bank employee, was confined last May 27, 2020, at the hospital due to cough and shortness of breath, with an initial diagnosis of “Ambulatory” and “Acute Respiratory Failure Secondary to Pulmonary Tuberculosis.”

The same day the said patient was subjected to an anti-body test and RT-PCR test. Unfortunately, the patient died the next day, May 28.

The anti-body test result, which was released prior to his death, showed the patient is negative of COVID-19.

Despite the test result, Michelle Jay Francisco-Napigkit, who served as the attending physician, allegedly issued the patient’s death certificate with an underlying cause of COVID Pneumonia Probable, Severe, which also reflected on the patient’s medical certificate and clinical abstract.

The RT-PCR specimen, on the other hand, which was forwarded to Vicente Sotto Memorial Medical Center (VSMMC), was released on June 3, 2020, which further revealed that the patient was negative of COVID-19.

Allegedly, officials of the Adventist Hospital in Cebu City claimed that the said patient died due to severe COVID pneumonia despite two tests (anti-body and RT-PCR ) showing negative results.

On June 15, 2020, the hospital officials prepared the PhilHealth claim documents and allegedly used the false death certificate as the basis when they submitted it to the government-owned insurance company, pursuing to claim the benefits package amounting to P333,519.

Based on the result of the investigation, PhilHealth then approved and released the claim on July 20, 2020, with all the attachments, including the negative RT-PCR test and Anti-body test.

Earlier, Oliva questioned PhilHealth on their basis of approving and releasing the claims since a probable case of COVID-19 is specifically defined.     /rcg



NBI-7 files charges against PhilHealth-7, hospital officials for upcasing



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TAGS: corruption, COVID-19, COVID-19 claims, NBI-7, NBI-7  Director Renan Oliva, PhilHealth-7

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