Hospital clerk found guilty of falsifying Philhealth claims

MANILA, Philippines —  A hospital clerk was found guilty of falsifying documents related to "ghost hemodialysis claims" for deceased patients at the state health insurer, Philippine Health Insurance Corporation (PhilHealth).

In a 20-page decision dated July 1, 2024, Pasig City Metropolitan Trial Court Branch 153 found Svend Rances guilty beyond reasonable doubt of 46 counts of Falsification of Official Documents by a Private Individual under the Revised Penal Code.

He will face an indeterminate prison sentence, with a minimum of six months of imprisonment and a maximum of three years, six months, and 21 days of prision correccional for each count. 

Rances will also be credited for time served under preventive detention and must pay a fine of P50,000 per count, with additional imprisonment if he is unable to pay.

What happened before

Rances' case stemmed from a complaint of physician Gjay Ordinal, president of TriHDCare Inc., which manages the hemodialysis unit of TriCity Medical Center Inc.

Ordinal asserted that Rances had falsified PhilHealth documents, including Claim Signature Forms, PhilHealth Benefit Eligibility Forms and Statements of Account to submit fraudulent claims for treatments allegedly received by twelve former patients of the hospital’s hemodialysis unit.

The hospital discovered the fraud in April 2019 when PhilHealth requested certified copies of claims forms and medical records for two patients, who was discovered to be already deceased on the claimed treatment dates.

This led to an investigation. During which, Rances admitted to filing false claims for these patients and others.

He forged signatures and submitted fraudulent claims to compensate for missed claims from previous periods. An audit revealed that Rances had filed false claims for 12 additional deceased patients.

They likewise discovered that TriHDCare had lapsed claims amounting to P1,378,000 in 2018 and P1,079,000 in 2019. 

Lapsed claims pertain to those claims that were not filed within the 60-day period from the time of discharge of the patient.

Court ruling

The court said that the prosecution was able to prove Rances’ guilt beyond reasonable doubt.

“The statements of the prosecution witnesses are sufficient to convict the accused. They testified in a spontaneous, categorical, frank, and straightforward manner, and their testimonies did not suffer any material inconsistency as would affect their credibility,” the court’s decision read. 

The Pasig court added that Rances’ confession of committing the crimes to the prosecution witnesses had also been made voluntarily and freely.

The court noted that a statement from an accused acknowledging their guilt of the charged offense, or any offense necessarily included in it, can be used as evidence against them.

“In the absence of a satisfactory explanation, one who is found in possession of a forged document and who used or uttered it is presumed to be the forger. If a person had in their possession a falsified document and they made use of it, as in this case, the clear presumption is that they are the material author of the falsification”, the court’s ruling read.