QC eye clinic denies PhilHealth’s accusation of fraud

An eye clinic accused of employing fraudulent scheme to milk PhilHealth of funds denied the allegation on Friday, saying it was not even informed of the complaint filed against them.

In a press statement, Dr. Raymond Evangelista, chief executive officer and president of Quezon City Eye Center, said up to the present, PhilHealth officials have not yet presented a single evidence or testimony to support the charges it made against QCEC.

“It was extremely irresponsible for them to drag the good name of our clinic, the reputation of which took years of hard work to build, into this controversy without caution and careful consideration as to its consequence,” he said.

Evangelista said more than suffering from the arbitrary suspension of reimbursement claims, the integrity of QCEC has been "unfairly and unnecessarily tarnished beyond repair."

“This is why we remain indignant and demand that PhilHealth retract its statements to at least diminish the damage it caused to our good name,” he said.

He said PhilHealth should have informed the QCEC of its supposed violations as stated in Circular No. 54 issued in 2012, which states that any institutional health care provider (IHCP) found in violation of agency circulars shall receive feedback from PhilHealth “requesting for prompt action to implement corrective measures addressing said violations...”

The circular states that the IHCP should “submit a plan of action to correct the same within fifteen days from receipt of feedback from PhilHealth.”

“In the case at hand, Philhealth did no such thing. While we support any effort to curb the anomalous use of PhilHealth funds and will cooperate and even aid in any investigation, we ask that this be done properly and in accordance with the principles of due process as promulgated by PhilHealth itself in its circulars,” Evangelista said.

He added that QCEC cannot defend itself if PhilHealth is unable to present evidence to support its charges as decreed by its own regulations.

PhilHealth president and CEO Alexander Padilla said QCEC and the Pacific Eye Institute in Makati are the objects of an investigation by the health insurer.

The eye clinics were supposedly recruiting patient-beneficiaries to avail themselves of eye procedures even if they don't need one, according to PhilHealth. It has already stopped paying the two eye centers whose claims ballooned from P69.5 million in 2013 to P169.496 million in 2014.

The Senate Blue Ribbon committee conducted an investigation on the allegations on Thursday.

PhilHealth said QCEC’s claims rose from P92.5 million in 2013 to P156 million in 2014.

In a text message to GMA News Online, Padilla said the QCEC was informed of the allegations against it.

“I think they were informed. We conducted an audit exit conference with them and these have been ventilated even during the Senate proceedings,” he said. —KBK, GMA News