THE Department of Justice (DOJ) has cleared four doctors and three medical staff of estafa and violation of the National Health Insurance Act of 2013 in connection with fraudulent Philippine Health Insurance Corporation (Philhealth) claims.

In a 24-page resolution, a DOJ panel of prosecutors dismissed the National Bureau of Investigation’s (NBI) 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, all of TriCity Medical Center in Pasig City.

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.

According to the DOJ, 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 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 (PNP-QDED) for examination. The PNP-QDED 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.

While the DOJ said that there was no probable cause to indict Rances for estafa, it said that there’s sufficient evidence to indict him for falsification under Article 172 of the Revised Penal Code.

Rances is also facing 53 counts of falsification charges filed by Ordinal before the Metropolitan Trial Court of Pasig City Branch 153 in connection with the fraudulent PhilHealth claim documents.

AUTHOR PROFILE

Hector Lawas