$100-M U.S. SCAM: HOSPITALS IN HEALTH FRAUD MAY LOSE PERMITS
MANILA, APRIL 27, 2008 (STAR) By Sheila Crisostomo - The Department of Health will move for the revocation of licenses of hospitals found to be involved in the $100-million health insurance scam in the United States.“If certain hospitals will be proven guilty, their licenses can be revoked. We’ll work for that,” Health Secretary Francisco Duque III said in a phone interview.
Duque said the DOH will never let erring medical practitioners besmirch the reputation of the local medical industry, which has been struggling to clear its image following a spate of scandals. He said the anomaly has also deprived many patients of medical subsidies.
The DOH has jurisdiction over government hospitals but private hospitals, just like other enterprises, need to secure business permits from the Department of Trade and Industry.
A US judge recently ordered Philippine-based Health Visions Corp. to pay back $100 million it swindled from the US military’s health insurance program.
The firm, which pleaded guilty to mail fraud, was ordered to liquidate all assets within 10 months and give the proceeds to the US government.
The anomaly involved the padding of reimbursement claims from the US health program by patients in connivance with their doctors.
The US government wants to find out how the Tricare Overseas Program Payment, a Pentagon-run program that insures 9.2 million current and former members of the armed forces and their dependents worldwide, was duped of more than $100 million by Health Visions.
Duque said the DOH is ready to help US authorities investigate the matter further, but only upon formal request.
He said even the Philippine Health Insurance Corp. or PhilHealth is beset with fraudulent reimbursement claims.
He said this prompted the DOH to implement a stricter screening of hospitals’ and doctors’ reimbursement applications.
The Professional Regulation Commission (PRC) also said it is prepared to help in the investigation, but will wait first for a formal request for assistance from the US.
PRC, chaired by Leonora Rosero, has jurisdiction over licensed professionals like doctors.
Rosero declined to say what sanction can be imposed against the doctors found involved in the anomaly.
“We have not seen the report. It depends on the severity of the offense. (Violations like this) can lead to the revocation of licenses but in this particular case, we’d like to see the report first,” she said.
Meanwhile, Justice Secretary Raul Gonzalez said the government is determined to help track down and arrest suspects in the scam who may be hiding in the Philippines.
Gonzalez said the government would immediately coordinate with US authorities for the extradition of the suspects upon their arrest.
Earlier, the National Bureau of Investigation said it is hunting a doctor and a patient suspected of involvement in the anomaly. The NBI declined to name the suspects or the province-based hospitals they dealt with.
“The country has an existing Mutual Legal Assistance Treaty with the United States, which provides for extradition of persons wanted in the US who fled here or vice versa,” he said in an interview.
But Gonzalez admitted that extradition of those involved in the scam might take years, depending on the pace of proceedings in the federal court handling the case. He cited as an example the extradition of former Manila congressman Mark Jimenez.
“There are hurdles that we will face in the court – usually legal maneuvers of the defense – and these are normally beyond the control of both governments,” he said.
“For example, the respondents would file several appeals and the governments would have to wait for the courts’ resolution of these issues before they could start moving for the extradition,” he said.
Tricare to blame
Dr. Rustico Jimenez, president of the Private Hospitals Association of the Philippines, said Tricare’s faulty or lax screening of health service providers applying for accreditation is largely to blame for the scam.
“For me it’s their fault. They should have accredited only the reputable health service providers and strictly monitored the program,” he told The STAR.
He said there might even be people in Tricare who were aware of the scam or had colluded with the suspects.
Meanwhile, a private lawyer said in a “letter to the editor” sent to The STAR, that many Filipino doctors were themselves “swindled” by unscrupulous health care providers.
Lawyer Joselito Oliveros said Tricare is administered by the Wisconsin Physicians Service Insurance Corp. (WPSIC), which “in turn deals with the health care providers here in the Philippines who are usually owners of hospitals and clinics.”
“Aside from submitting bogus/bloated claims to WPSIC, these erring health providers had also made Filipino doctors work for them under this program with a promise that they will be paid for their services once WPSIC remits payments under the Tricare program,” he added.
But even after collecting from WPSIC, the health service providers “would not give anything to the doctors.”
“Most of these doctors couldn’t sue simply because whatever documents they need to prove payments by WPSIC are either with the health care providers (who wouldn’t show the documents to them for obvious reasons) or WPSIC (to which they have no access),” he said.
Oliveros added that he has doctor-clients who have pending cases against these providers in courts. – With Edu Punay
Reported by: Sol Jose Vanzi
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