DoJ clears doctors, staff over falsified insurance claims

The Department of Justice on Sunday announced that it has absolved several executives and staff of TriCity Medical Center in Pasig City of estafa and violation of the National Health Insurance Act of 2013.

The charges were previously filed by the National Bureau of Investigation in connection with fraudulent Philippine Health Insurance Corporation claims.

In a 24-page resolution, the DoJ Panel of Prosecutors dismissed the NBI’s case against Doctors Gjay Ordinal, Enrico Cruz, Froilan Antonio de Leon and Lourdes Rhoda Padilla and hospital staff Cherry Flores, Arlene Sebuc and Svend Rances.

The resolution was signed by Senior Assistant State Prosecutor Marmarie Satin-Vivas, Assistant State Prosecutor Ma. Richelle Oliva and Prosecution Attorney Eugene Yusi and approved by Prosecutor General Benedicto Malcontento.

Contrary to the NBI’s claim, the DoJ said the elements of estafa under Article 315 (a) of the Revised Penal Code with respect to Doctors Ordinal, De Leon and Padilla were absent as they were able to “sufficiently establish that they did not participate in the falsification of claim documents submitted to PhilHealth.”

The doctors said that they had no knowledge that the professional fees they received were from the fraudulent claims filed with PhilHealth since the professional fees were paid in lump sum.

Upon learning of the fraudulent claims, the doctors conducted their own investigation, discovering that fraudulent claims were also filed for at least 12 other former patients, all of whom were already deceased at the time they purportedly received treatments. They immediately reported all of these findings to PhilHealth.

In addition, the three doctors submitted the Claim Signature Forms to the Philippine National Police-Questioned Document Examination Division for examination and the agency later confirmed that the doctors’ signatures were indeed forged.

“Hence, they did not commit any fraudulent representations in the falsified claim documents submitted to PhilHealth,” the resolution said.

Read more Daily Tribune stories at:

Follow us on social media
Facebook: @tribunephl
Youtube: TribuneNow
Twitter: @tribunephl
Instagram: @tribunephl
TikTok: @dailytribuneofficial