US Vet in Nbi Watch List in US Military Health Insurance Scam

A doctor and a US veteran are currently being held under the surveillance of Philippine authorities in connection with the scam that victimized an American military health insurance programme.

Lawyer Claro de Castro, chief of the National Bureau of Investigation's Interpol division, stated extradition cases are coursed through the Department of Justice (DOJ). He explained once the DOJ approves an extradition request a warrant of arrest will be issued and the NBI will serve it.

However, De Castro denied requests to reveal the identities of the two suspects so as not to jeopardize police operations.

In 2007, de Castro said a US veteran was extradited to the United States for his involvement in a scam that had been paid by TRICARE, the US Department of Defence’s worldwide healthcare programme for active duty and retired uniformed services members and their families, more than $100 million through fraudulent claims.

The scheme involved Philippine health providers, which were accused of getting kickbacks from false claims, inflated by as much as 2,000 percent, filed with TRICARE for medical services.

De Castro said the American veteran’s plea agreement with the US government was a bargain. The bargain consisted of the US government reduced the veteran’s pension after he admitted to overcharging his health claims by an estimated $35,000. The veteran had since returned to the Philipines.

Justice Secretary Raul Gonzalez, however, said his office has yet to receive an extradition request from Washington. ‘If there are people here and they have been indicted in the US and they ask us for extradition, we have no recourse but to comply because of the extradition treaty,’ Gonzalez said.

He anyhow maintained that the extradition proceedings might take particularly long, in particular if the accused questions the extradition request before the local courts.

Gonzalez added that he was not surprised when reports regarding the fraud came out, citing an incident in which a health provider operating in Subic, Angeles City and Bacolod was blacklisted due to fraudulent claims.

The justice chief said the health provider has overcharged and manipulated a patient’s medical records.

On April 22, 2008, the online edition of Marinas Variety reported that a Filipino doctor was arrested and charged with conspiracy, aiding and abetting, and filing of false claims in Wisconsin in connection with the kickbacks he purportedly got from TRICARE claims.

It was reported that Diogenese Dionisio would allegedly give the beneficiaries between 40 to 80 percent of the amount of the claim while the rest of the money would go to him and his clinic, CDMF Medical Clinic in Mandaluyong City. In 2006, a former American administrator of Philippine health provider, Health Visions Corporation, pleaded guilty to defrauding the TRICARE program. Thomas Arthur Lutz was charged with participating in a conspiracy with Health Visions and a physician in the Philippines to double bill TRICARE and kickback the inflated payments to the health provider.

On Thursday reports said a US judge ordered Health Visions to pay back the $100 million it swindled from TRICARE. An Associated Press report said Health Visions was ordered to liquidate all its assets within months and give the proceeds to the US government. On top of the $99.9 million in restitution, Crabb directed the company to forfeit an additional $910,000 and pay a $500,000 fine.

Under Crabb’s decision, the report said the Health Visions will be required to sell off land, office buildings and hospitals in the Philippines and an airplane and houses in the US. Meanwhile, Commissioner Eduardo Malinis of the Office of Insurance said Health Visions is not part of its roster of insurance companies.