PhilHealth suspends WellMed accreditation


PhilHealth suspends WellMed accreditation

Mayen Jaymalin (The Philippine Star) – June 19, 2019 – 12:00am

MANILA, Philippines — The Philippine Health Insurance Corp. yesterday suspended the accreditation of WellMed Dialysis Center amid fraudulent and ghost claims filed with PhilHealth on behalf of deceased patients.  

PhilHealth officer-in-charge John Basa said WellMed is now barred from the National Health Insurance Program (NHIP).

Basa said the withdrawal of WellMed’s accreditation was in accordance with the agency’s previous decision to withhold payment of claims to the dialysis clinic.

He said PhilHealth has stopped paying the claims of WellMed since February.

According to Basa, PhilHealth grants accreditation to qualified health care providers to be able to participate in the NHIP.

He said a health care provider should meet the qualifications and capabilities provided under the guidelines and standards of the agency.

“An accreditation can be withdrawn at the discretion of the corporation upon evaluation of the health care provider’s capacity and integrity,” the PhilHealth official said.

WellMed was accredited in August 2015. The dialysis clinic’s accreditation is set to expire on Dec. 31, but the company got involved in a scam that allegedly defrauded PhilHealth of millions of pesos.

The agency advised WellMed patients to transfer to other dialysis centers to be able to avail themselves of benefits.

Earlier, PhilHealth filed 28 administrative cases against WellMed after it was discovered that the clinic had been making fraudulent dialysis claims on behalf of dead patients since 2016.

Duque ready to face probe 

Health Secretary Francisco Duque III said yesterday he is willing to face an investigation on the multibillion-peso dialysis scam.

“I am willing to face and support a probe to be conducted by the National Bureau of Investigation,” Duque said in an interview with The STAR.

He said PhilHealth officials in charge of the agency’s operations would also cooperate in the investigation.

Since he chairs the PhilHealth board, Duque said he could only testify about the agency’s policies.

“As members of the board, we are not aware of or involved in the operations of PhilHealth unless it is brought to the board,” he explained.

“To my understanding, they just want to know from me, as the former CEO, how PhilHealth is being run,” Duque added. 

Justice Secretary Menardo Gueverra earlier said the health chief may be called to appear in the NBI probe.

Guevarra made the statement after Sen. Panfilo Lacson questioned why Duque did not join other PhiHealth officials, led by its president Roy Ferrer, in tendering their courtesy resignation amid the dialysis scam.

Sought for comment on Lacson’s  statement, Duque said the senator is entitled to his own opinion.

Duque said he would not resign.

The health chief earlier also denied involvement in the alleged misuse of Overseas Workers Welfare Administration funds as reported by Lacson.

“For the information of Senator Lacson, this case was dismissed by the ombudsman in 2012 and dismissed with finality by the Supreme Court in 2013 for lack of evidence,” Duque said.

“I have been in public service for two decades and I have never been convicted of any wrongdoing,” he said.