BACOLOD City – Task Force Crusaders national deputy commander John Chong revealed that more or less 3,000 patients were victimized by an alleged insurance fraud here involving cataract treatments and operations.
Chong said this was discovered in the investigation conducted by a Department of Health (DOH) team under lawyer Dennis Guevarra.
The DOH team arrived here last week after Chong revealed the alleged fraud in a letter to Health Secretary Paulyn Jean Rosell-Ubial.
In his letter to Ubial, Chong said they received complaints from medical practitioners claiming that the fraud “involves the Philippine Health Insurance Corp. (PhilHealth), some hospitals, some members of the Philippine Medical Association (PMA) some of whom are joining this so-called Cataract Foundation and many social and health workers of the government.”
“Despite PhilHealth’s sanctions imposed many years ago against some hospitals, massive and widespread recruitment of cataract patients with PhilHealth by a group called Cataract Foundation, enjoining government health workers particularly in Negros Occidental goes on,” the letter said.
It added: “The patients are reportedly taken to private hospitals in groups, although one particular private hospital is the most preferred where cataract patients are operated by three doctors of the same surname. They charge their services and professional fees to PhilHealth. The foundation is also getting something, although supposedly gives free cataract surgery but it charges fees against PhilHealth.”
Chiong claimed that the “practice has been going on and even PhilHealth did not lift a hand despite the pattern, causing losses in millions of pesos to the government and depriving others who also need medical and surgical assistance from the government.”
Chiong said he also turned over to the DOH on May 22, 2017 documents pertaining to the case. He also joined them in the investigation as an observer.
He said the team also visited several hospitals here to peruse their records. A representative from PhilHealth here was also present.
Chong said the DOH team discovered that the so-called Cataract Foundation filed reimbursement claims with PhilHealth aside from collecting fees from the patients.
“This is highly questionable because a foundation charges payment or collects from the patients,” he stressed.
The team also discovered that certain health workers acted as “agents” for the foundation to look for patients.
Chong said the legal team informed him that they will finish the investigation in a week’s time and by then charges will be filed against those involved in the alleged fraud.
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