MANILA (UPDATE) – The National Bureau of Investigation (NBI) has filed criminal complaints against the owner of a dialysis center accused of making "ghost" claims with the Philippine Health Insurance Corp. (PhilHealth).
The NBI, on behalf of PhilHealth, filed with the Department of Justice (DOJ) on Tuesday complaints for estafa and falsification of documents against businessman Dr. Bryan Sy, owner of WellMed Dialysis Center based in Quezon City.
The charges were based on allegations of two former WellMed employees that Sy filed benefit claims with PhilHealth on behalf of deceased patients, taking advantage of a loophole in the patient’s death reporting system of PhilHealth.
Also named in the complaint were other officers of WellMed: Dr. John Ray Gonzales, medical director; Claro Sy, chairman; Alvin Sy, corporate treasurer; Therese Francesca Tan, purchasing officer; Dick Ong, administration officer; and physicians Dr. Porshia Natividad and Joemie Soriano.
Also charged were Edwin Roberto and Liezel Aileen De Leon, the two former employees who bared the alleged ghost claims scheme.
Under the scheme, the clinic supposedly received payments from PhilHealth for dialysis treatments even though some of the patients have long been dead.
Roberto, a former WellMed assistant manager, claimed in his sworn statement that it was Sy himself who ordered him on March 30, 2016 to try to charge PhilHealth with claims of two dead patients amounting to P2,600. Sy allegedly instructed De Leon to prepare the reimbursement forms.
Roberto said before he resigned in March last year, PhilHealth had paid WellMed a total of P600,600 for 200 sessions using claims for the deceased patients.
There was also unpaid claims worth P208,000 for 80 sessions, which he said was eventually paid.
In all, Roberto said PhilHealth paid for ghost treatments amounting to P808,600.
In the complaint, the NBI cited the sworn statement of John Cueto, a PhilHealth special investigator, who said WellMed continues to file PhilHealth reimbursement forms for their patients.
Sy, Roberto and De Leon were arrested while attending NBI’s investigation on Monday afternoon.
The agency justified the arrest as a case of “hot pursuit,” which allows warrantless arrests “when an offense has just been committed” and the arresting officer “has probable cause to believe based on personal knowledge of facts or circumstances that the person to be arrested has committed it.”
Sy’s wife, Therese Francesca Tan-Sy, who was also named in the complaint, filed a petition for issuance of a writ of habeas corpus before the Manila Regional Trial Court Branch 20 questioning her husband’s arrest and asking for his immediate release.
The petition is now submitted for resolution, according to Sy’s lawyer Rowell Ilagan.
Sy was brought before the Manila court Tuesday before he was taken to the DOJ for inquest proceedings.
Justice Secretary Menardo Guevarra said in a text message that both the writ of habeas corpus petition and inquest proceedings will determine whether there is basis to hold Sy without a warrant.
“It’s a question of who resolves it first,” he said.
A Manila court on Tuesday evening denied Sy’s petition for writ of habeas corpus, saying the lack of probable cause for warrantless arrest was not enough ground.
President Rodrigo Duterte on Saturday ordered the arrest of Sy and on Monday asked all PhilHealth officers to resign.
Presidential Spokesperson Salvador Panelo on Tuesday said PhilHealth officials accepted the President’s request and thanked him for the opportunity to serve.-- with reports from Niko Baua and Mike Navallo, ABS-CBN News