ANOTHER GHOST DIALYSIS SCAM?

Lacson points out alleged excessive PhilHealth claims of B. Braun Avitum

Senator Panfilo Lacson on Tuesday said there is an indication that the dialysis center which has been previously entangled in PhilHealth's controversial Interim Reimbursement Mechanism (IRM) and wrongful crediting of over P9 million to a rural bank may also be involved in a "ghost dialysis" scam.

During a Senate hearing, Lacson pointed out that six branches of B. Braun Avitum Philippines Inc. allegedly recorded an excessive number of dialysis sessions compared to their actual capacity.

"In 2018 ang isang QC branch ng B. Braun Avitum ay umabot hanggang 133.78% ang sessions to capacity ratio ng kanilang 15 dialysis machines, samantalang 90% lang dapat ang threshold capacity or 72 sessions per month ayon sa PhilHealth," he said.

"The data set was culled from PhilHealth’s own tracking system called MIDAS, or Machine Learning Identification, Detection, and Analysis System, which suggested that the deviation in their regression models tells us the possible presence of ghost dialysis patients, if not ghost dialysis machines," he added. "Now I dare ask–is this another case of ‘WellMed dialysis scam’ in the making?"

Lacson stressed that from 2015 to 2018 alone, the claims paid by PhilHealth to B. Braun Avitum amounted to P811 million. He asked why it apparently continues to gain the favor of PhilHealth—even getting over P45 million under the IRM this year.

"Noon pa naka-flag itong B. Braun Avitum, anong agimat mayroon 'yan bakit hanggang ngayon napakabilis makasingil at wala pa namang kinalaman sa COVID-19, nakakasingil pa, nauuna pa sa iba?" he asked.

PhilHealth senior vice president Renato Limsiaco Jr. said he was not aware there were such MIDAS findings.

"Di ko rin po nakikita at wala akong information na mayroon pong ganiyang report on the part of the MIDAS," he said.

"Eh ikaw ang may hawak ng pera dapat responsibilidad mo mag-due diligence ka bago ka mag-release ng pera. Ni hindi mo man lang tiningnan, 'yung MIDAS may history pala na lampas-lampas 'yung kanilang session sa kapasidad nila," Lacson responded.

Limsiaco said the regional offices were in charge of the matter and the analysis of claims is under a different office.

"Nevermind, nakakapagod ang sagot mo," Lacson said and moved on to another topic.

B. Braun Avitum, for its part, has previously invoked the regularity of its transactions with PhilHealth and vowed to cooperate with the government for transparency.—AOL, GMA News