NBI files complaint vs. hospital officials over PhilHealth claims for dead patients

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Metro Manila (CNN Philippines, September 23) — The National Bureau of Investigation said Thursday it has filed a complaint before the Department of Justice, recommending that seven officials and staff of Tricity Medical Center in Pasig City be criminally charged for "fraudulent claims" with the Philippine Health Insurance Corporation (PhilHealth).

NBI officer-in-charge Eric Distor in a statement identified the suspects as hospital administrator and board member Enrico Cruz; Drs. GJay Lalu Ordinal, Froilan Antonio de Leon, and Lourdes Rhoda Padilla; nurse Cherry Flores, staff Arlene Sebuc, and hospital clerk Svend Rances.

The recommended charges against them are estafa and violation of Section 44 of the National Health Insurance Act of 2013.

The NBI complaint stemmed from an intelligence information alleging Tricity “has been fraudulently facilitating or claiming reimbursement from PhilHealth for its supposed hemodialysis patients which turned out to be non-existent or deceased already at the time of the supposed hemodialysis treatment.”

A year-long probe by the bureau’s anti-graft unit found that the hospital filed at least 318 fraudulent claims worth ₱824,200. The NBI added that investigation further suggested a “strong possibility” the number of fraudulent claims filed is higher, with the Philhealth Database showing up to ₱4.3 million claims involving the identified patients.

CNN Philippines is seeking the comment of the hospital officials and personnel named.