MANILA, Philippines - The stunning news filtered out through the wires last Thursday. An elaborate scam based in the Philippines had swindled the Pentagon out of billions of pesos in fraudulent health care claims. The exact amount of the total fraud is still undetermined, but it has been reported that one health care provider in the Philippines, Health Visions Corp., allegedly defrauded the US Defense Department’s Tricare program of almost $100 million between 1998 and 2004. It has also been reported that one Filipino doctor already arrested by US agents had by himself or with others swindled the Tricare program of $2 million in false or padded claims.
US government agencies have thrown the blame at one another. The Office of Inspector General of the Department of Health and Human Services, for instance, criticized Tricare management for waiting an inordinately long time before suspending Health Visions. A former official of the Defense Department, meanwhile, took the Inspector General to task, for refusing his requests to send additional investigators to the Philippines.
There was certainly something to investigate. According to the Associated Press, the health insurance claims filed by some 9,000 retired American servicemen living in the Philippines ballooned from $3 million in 1998 to more than $60 million in 2003.
There is also, certainly, enough blame to go around. US authorities seemed to take their time, despite evidence gathered years ago. But at least the US government has started to crack the whip. The Arroyo administration must do the same.
Our impression is that Philippine government officials are either still in denial or are substituting talk for action. National Bureau of Investigation agent Claro de Castro Jr., for example, doubts whether the total cost of the scam to the US government could reach a hundred million dollars. “That’s too much,” he said. He pointed to one case that involved only $40,000—but in fact the investigation in the United States has gathered evidence of a systematic effort to defraud the health insurance system. Add enough similar cases, and the total will undoubtedly be substantial.
Justice Secretary Raul Gonzalez, who oversees the work of the NBI, declared that the country would cooperate with the US government—but in the next breath almost seemed to promise the exact opposite. “The downside [to the requests to extradite certain individuals to the United States] would be whatever legal maneuvers their lawyers will do. If the court will issue writs, for example, we have to comply until we can have them resolved.”
Coming from a lawyer famous for his damn-the-torpedoes approach to legal requirements, this is saying something. Indeed, the AP quoted a US government lawyer to the effect that about 20 of the 37 suspects already charged were still at large, many of them because of the failure of the extradition requests.
It is in our national interest to cooperate as fully as we can, because the reputation of our doctors and nurses are at stake. Yes, we must also consider the rather unusual timing of the release of pertinent information—at the exact time the US Senate deliberated on a bill granting a pension to Filipino veterans who served in the US armed services during World War II. (The bill passed, and must now hurdle the US House of Representatives.)
But the damage this unconscionable scam does to the reputation of our medical community—even if it were proven that Filipino medical personnel involved were merely accomplices, not masterminds, in an elaborate scheme—will be more lasting than a stray and frivolous comment about the quality of Philippine medical schools in “Desperate Housewives.”
Here we have the possibility of Filipino doctors and nurses, in Philippine hospitals and clinics, knowingly taking part in a giant fraud. This is terrible news, given the encouraging growth in medical tourism and the continuing demand abroad for Filipino medical personnel. What are we doing taking our time?
In an AP story, a Tricare spokesperson “said the fraud has been hard to prove because of language barriers, a lack of cooperation from providers and limited law enforcement resources.” Surely the Philippine government can help, on at least two of these three factors. It’s bitter but necessary medicine.
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