Upcasing Charge

Adventist Hospital – Cebu: We complied with PhilHealth guidelines

By: Mae Fhel Gom-os - Multimedia Reporter - CDN Digital | July 03,2021 - 10:45 AM

Atty. Renan Oliva, Central Visayas director of the National Bureau of Investigation (NBI), speaks during a press conference on Thursday, July 1, 2021. | CDN Digital file photo

CEBU CITY, Philippines  –  Officials of the Adventist Hospital-Cebu (AHC) said they complied with guidelines set by the Philippine Health Insurance Corporation (PhilHealth) when they filed for claims for the treatment of a patient who later on died due to severe COVID pneumonia.

At the same time, they also denied allegations by the National Bureau of Investigation (NBI-7) that at least six of their medical personnel connived with PhilHealth’s Central Visayas office in making fraudulent claims in 2020.

“We are confident that our hospital staff and physician performed their respective duties and responsibilities with utmost truthfulness and benevolence and in accordance with the ‘updated’ guidelines set by the PhilHealth. We are certain that our PHIC claims underwent through a stringent process in strict conformance to the criteria and guidelines of PhilHealth,'” the hospital said in a statement released on Friday, July 2.

NBI-7 has accused personnel of the Adventist Hospital in Cebu City of upcasing, a practice of some health providers to pad claims to collect higher reimbursements, after they made claims that a patient died due to severe COVID pneumonia despite the release of two negative anti-body and RT-PCR test results.

NBI-7 Director Renan Oliva said PhilHealth officials approved the claims and released P333, 519 to the hospital.

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

In their statement, hospital officials said NBI-7 made a public announcement of the case that was filed against their medical staff without first furnishing them a copy of said documents and giving the concerned personnel an opportunity to refute the allegations against them.

“We are disheartened that NBI-7 released a public announcement on the alleged fraudulent PHIC claim and connivance with the said agency without furnishing us a copy of the formal complaint and giving our staff and physician the opportunity to refute the accusations against them. Had the attending physician been given the chance to explain the clinical/medical management, her sound expertise and professional judgment could have strongly shed light to the investigation,” part of the statement reads.

The hospital said that concerned personnel are now preparing their counter affidavit which they will file before the Office of the Obudsman – Visayas as soon as they are furnished a copy of the complaint.

AHC also made a commitment to continue to support the government’s effort to flatten the COVID-19 curve while stressing that they “bravely rallied together despite the uncertainties and threats, and stress, adding that one-third of its workforce were contracted with the virus.”

PhilHealth-7 has also denied allegations of corruption hurled by NBI-7 .

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

Officials of the government-owned insurance company said they continue to comply with guidelines in the processing of claims based on PhilHealth Circular 2020-0009 or the “Benefit packages for inpatient care of probable and confirmed COVID-19 developing severe illness/outcomes.” / dcb








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TAGS: Adventist Hospital-Cebu (AHC), NBI-7, PhilHealth, upcasing

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