NBI files new complaint vs. PhilHealth officials at Ombudsman

The National Bureau of Investigation (NBI) on Monday filed a new criminal complaint against officials of the Philippine Health Insurance Corp. (PhilHealth) and of a dialysis provider over alleged irregularities in the insurer's Interim Reimbursement Mechanism (IRM).

Former PhilHealth chief Ricardo Morales, Executive Vice Presidents Arnel De Jesus and Renato Limsiaco, Senior Vice President Israel Francis Pargas, and 10 other PhilHealth officers face new complaints for graft and misappropriation of PhilHealth funds before the Office of the Ombudsman.

The NBI also filed administrative complaints against them for grave misconduct and gross negligence.

Officers of the Taguig City-based B. Braun Avitum Philippines, Inc. were also named as respondents.

The NBI said the complaint is for the "irregular release and utilization" of the P33.8 million in IRM funds granted to B. Braun Avitum.

Investigators claimed that the company received the IRM fund before the effectivity of a PhilHealth circular on the IRM, which the insurer defines as a "special privilege" for financial assistance to eligible health care institutions affected by "fortuitous events."

The NBI also alleged that the P38 million was used for the reimbursement of claims for hemodialysis procedures even before the COVID-19 pandemic.

The bureau said PhilHealth still gave the clinic the funds despite its supposed track record of "numerous administrative cases for filing of multiple claims, breach of warranties of accreditation, claims for non-admitted/non-treated patients and unjustified admission beyond accredited bed capacity."

B. Braun Avitum's subsidiary also received P15.9 million in IRM funds, the NBI alleged.

President Rodrigo Duterte last year directed a Department of Justice-led task force to investigate alleged corruption in PhilHealth.

The task force found that PhilHealth executives were negligent in their duties in the IRM, certain procurements, and accountability mechanisms. The NBI filed its first complaint last October.

Duterte has since widened the investigation to cover corruption in the "entire government."—LDF, GMA News