Solon looks into 'suspicious' cataract medical missions
Private practice of at least six Ilonggo eye specialists or opthalmologists and its link with two private hospitals based in Bacolod City are under special scrutiny by the government's Philippine Health Insurance Corporation (PhilHealth).
With nearly two years in continued and widened investigation, the modus operandi has now been disclosed by PhilHealth probers with at least P100 million in PhilHealth cataract claims easily generated by the group.
Bared in ongoing budget hearing in Congress, Representative Janette Loreto-Garin (First District, Iloilo) confronted PhilHealth officials on the said subject. This, as Garin sought for answers with Health Secretary Francisco Duque III confirming the practice through "seekers" cum agents of private hospitals involved.
And it is not only exclusive to indigent patients in Bacolod and Negros Occidental, The News Today (TNT) gathered with patients reportedly coming from the provinces of Antique, Guimaras and Capiz. One Iloilo town in the Fourth District was also said to have been visited by the "seekers/agents" with the irresistible offer for free cataract operation to be done in Bacolod City.
The modus, the lady solon disclosed, involved unsuspecting PhilHealth members responding to supposedly "free" medical missions for cataract cases. The entire process would include free transportation, free overnight stay with meals to the hospitals involved.
"Too good to be true," Garin said in the subcommittee hearing on the proposed 2008 P16.2 billion budget of the Department of Health.
Secretary Duque in yesterday's Philippine Daily Inquirer news item was quoted as having said that the doctors "cast their net on indigents and pay for the premiums and operate on them."
"I know it's a difficult and ambitious statement to say that we will completely get rid of all these shenanigans," the Secretary in same news report said. "(But) we assure the congresspersons that PhilHealth has been working to curb, if not eliminate (the practice)."
Asked for comment, PhilHealth Regional Office 6 through Public Relations Officer Larry Tabsing said all related reports and investigation has since been submitted to PhilHealth Central Office. Officer-in-Charge Alberto Manduriao was on official trip.
Tabsing confirmed that orders were indeed issued for PhilHealth's Anti-Fraud Team to investigate. He refused to name the hospitals involved yet said that two separate probes were made. A team from PhilHealth's Legal Section and the Accreditation, Quality and Assurance Section were dispatched.
One report had specifics on the Ilonggo doctors involved, the amount of claims gathered from PhilHealth, the hospitals' claims in millions and affidavits of those recruited including the names of their recruiters.
Garin in a TNT interview decried the modus operandi while saying that added to the highly unethical practice of the hospitals and the doctors involved are reports of possible malpractice.
One PhilHealth finding was the testimony of a former patient who lost her eyesight after the operation. Yet another patient was treated supposedly by this particular specialist who turned out to be abroad at the time of the medical mission.
"PhilHealth is one of the laudable projects of the government. And we have seen it wounded in the past in the postal checks scam. Are you, Mr. Secretary waiting for it to die?," Garin told Secretary Duque in the hearing while pressing for update on what happened to the cases filed in the past, if any.
Dr. Karen Rivera-Francia, president of the Philippine Academy of Opthalmologists- Western Visayas Chapter has since filed a complaint in behalf of practicing eye specialists in the region.
The practice, Francia said, is not tolerated by their association as they vowed to work closely with PhilHealth.
One document obtained by TNT showed huge disparity in PhilHealth claims of Opthalmologists here in the city to those identified by PhilHealth as involved in the Bacolod-Negros Occidental medical missions.
For instance, total claim of one doctor reached P5.1 million in six months time to that of one Iloilo City doctor at P120,000.
"It is not only about the money. It is more about the highly-unethical practice that they do and at the expense of the indigents. Remember, the PhilHealth is designed to help those who cannot afford the high cost of medical insurance. Yet sadly, it has become the milking cow of these enterprising hospitals and doctors. How ironical indeed," one eye specialist who requested anonymity said.