Bacolod hospital penalized for fabricating claims

MANILA, Philippines — A hospital in Bacolod City was slapped heavy sanctions after it was found to have fabricated claims for cataract surgeries conducted on patients recruited through medical missions. Online news site Visayan Daily Star (www.visayandailystar.com) reported Friday that the Philippine Health Insurance Corp. (PhilHealth) issued its verdict in a 14-page decision dated Sept. 16. According to the report, the PhilHealth Arbitration Department found the Bacolod Our Lady of Mercy Specialty Hospital guilty of six counts each of "padding of claims" and "breach of accreditation." It ordered the hospital to pay a fine of P10,000 for each count or P120,000. It also suspended the hospital's PhilHealth accreditation for 36 months, three months for each count. PhilHealth also ordered the denial of payment for the six claims found to have been padded, or for the hospital to refund the health insurance agency if the claims have already been paid. But Dr. Evangeline Johnson, BOLMSH chief executive officer, said the resolution is still subject to a motion for reconsideration, and not yet final and executory. "Bacolod Our Lady of Mercy Specialty Hospital and its staff, nurses and doctors reserve their rights to seek due process in the proper legal forum, to bring out the truth and obtain justice," the hospital said in a statement. It added it had been "subjected to false and baseless accusations" but will continue to receive and admit patients both members and non-members of PhilHealth. Jay Villegas, manager of PhilHealth's Fact-Finding and Administrative Investigation Department, said in a telephone interview that the hospital has until October 1 to appeal the ruling or it will become final and executory. The case stemmed from a complaint filed by the PhilHealth's prosecution department last Jan. 7, concerning the PhilHealth claims of six patients who underwent cataract surgery. The hospital had filed claims that it utilized oxygen and intravenous fluids during the surgeries on the patients. But verification with the patients showed no oxygen or IV fluids were administered at any time during their confinement. The hospital had moved for dismissal of the complaints and questioned the authority of PhilHealth officials and employees who conducted the investigation to administer oaths to documents related to case. It claimed that the complaint was "based on hearsay" and on "pre-fabricated statements." The hospital maintained that its claims were legitimate and insisted that oxygen and IV fluids were used. It presented affidavits of attending physicians and nurses to support its defense. The hospital also submitted affidavits of three of the patients which refuted their earlier statements given to the PhilHealth investigating team. But PhilHealth affirmed its authority to investigate and prosecute the complaint as well as the authority of PhilHealth personnel to administer oaths to the patients' affidavits. It gave credence to the statements of the patients given to investigators rather than the affidavits submitted by the hospital. "In the instant case, we find the evidence of the prosecution more credible that must be accorded greater evidentiary weight," the decision stated. It said the sworn statements of the patients given to investigators are "clear and unambiguous in their declaration that oxygen and IV fluids were not given to them." PhilHealth also noted the affidavits of the three patients submitted by the hospital were undated and not notarized. It also observed as suspicious that the statements were "identical in all details," including the words used. A PhilHealth position paper said the patients are recruited and screened "in the guise of free medical outreach programs" through "recruiters-agents" sent out by ophthalmologists in coordination with the hospitals where the operations are performed. - GMANews.TV