PhilHealth-Central Visayas official defends agency

FOLLOWING the recent criminal and administrative raps filed by the National Bureau of Investigation (NBI) 7 against its officials and personnel for alleged anomalies in Covid-19 claims, the Philippine Health Insurance Corp. Central Visayas (PhilHealth 7) has maintained that it only abides by the guidelines in processing the Covid-19 claim documents.

PhilHealth 7 vice president Edwin Oriña said in a statement released on Friday, July 2, 2021, that the agency “sticks to its previous statement that it continues to abide by the guidelines in processing claim documents per published circulars which are developed by its policy-making sector and are approved by the PhilHealth board.”

Oriña said the basis of PhilHealth 7 for processing the claims is PhilHealth Circular 2020-0009, which sets the guidelines in giving “benefit packages for inpatient care of probable and confirmed Covid-19 developing severe illness/outcomes.”

The circular, he said, was published in a national newspaper on April 14, 2020.

Oriña said the circular is based on the Philippine Society of Microbiology and Infectious Diseases’ interim guidelines on the clinical management of adult patients with suspected or confirmed Covid-19 infections version 2.1 that was published on March 31, 2020, and the World Health Organization’s guidelines.

The NBI 7 filed the new charges before the Office of the Ombudsman-Visayas last Tuesday, June 29.

PhilHealth 7 officials Arlan Granali, the former acting regional vice president; Francis Javier, division chief-HCDMD; Joan Tiu-Ayuson, medical specialist IV/section head of the Benefits Administration Section (BAS); Josette Bacalso, fiscal controller IV; Anecito Ramas Jr., social insurance officer 1; Anthonneette Maamo, BAS clerk III; Nina Christine Lunday, BAS social insurance officer 1; Kenneth Donalyo; and Adventist Hospital officers and employees Dr. Michelle Jay Francisco-Napigkit, attending physician; Cefriano Julian Jr., chief of the patient business department; Ma. Kenneth La Sage, clerk, PhilHealth section; Dicchel Grace Napigkit, billing clerk; Red Ford Gargarila, billing clerk; and Romeo Rando Jr., registered nurse, are criminally charged with an alleged violation of Section 3 of Republic Act (RA) 3019, or the Anti-Graft and Corrupt Practices Act, and alleged malversation of public funds or property penalized under Article 217 of the Revised Penal Code.

Granali, Javier, Tiu-Ayuson, Bacalso, Ramas, Jr., Maamo, Lunday and Donalyo were also administratively charged with violating the Revised Administrative Code of 1987 and violating RA 6713, or the Code of Conduct and Ethical Standards of Public Officials and Employees. Additional charges were filed against Francisco-Napigkit of the Adventist Hospital for allegedly issuing false medical certificates.

Oliva, on Thursday, July 1, said these cases stemmed from the Covid-19 claim named to a certain Ervin Gayrama, a retired bank employee and PhilHealth beneficiary who was confined from May 27 to 28, 2020, at the Adventist Hospital Cebu because of cough and shortness of breath.

Oliva earlier said Gayrama’s initial diagnosis was “ambulatory” and “acute respiratory failure secondary to pulmonary tuberculosis.”

He died at the hospital on May 28, 2020.

His attending physician Francisco-Napigkit, Oliva said, then issued his death certificate with the underlying causes as “Covid pneumonia probable, severe; antecedent cause: septic shock secondary to Covid pneumonia, and acute kidney injury secondary to Covid pneumonia probable as an underlying cause.”

Oliva said during that time the result of Gayrama’s initial antibody test was already available and on June 3, 2020, the negative result of Gayrama’s RT-PCR test was released by the Vicente Sotto Memorial Medical Center.

Despite the negative test result, Oliva said Gayrama’s death certificate was forwarded to the Office of the Civil Registrar in Cebu City with “Covid pneumonia probable, severe” as cause of death, on June 8, 2020.

Seven days later, on June 15, the Adventist Hospital officers prepared the PhilHealth claim documents and used the alleged false death certificate as basis when they submitted it to PhilHealth and continued to claim the benefit package of P333,519. (WBS)