All the Times PhilHealth Came Under Fire for Alleged Fraud

It's not the first time that the government agency has been investigated.

ILLUSTRATION War Espejo

(SPOT.ph) Philippine Health Insurance Corporation or PhilHealth, for short, is our country's version of universal health coverage. It's been around since 1995 and is especially useful for Filipinos who don't have medical benefits from their employers. But it's not free—employees and employers share the monthly P1,800 premium (as of 2020) while Overseas Filipino Workers, self-earning individuals, and kasambahay pay their annual contributions on their own to ensure that they're medically insured, at least partially.

Aside from generating budget through our hard-earned money, PhilHealth also gets a share of the national budget (which again comes from us through the taxes we pay), and tobacco and liquor taxes. Now the government-run agency is under investigation for alleged fraud, ranging from an inflated IT-related budget to a "mafia" within the system. But this isn't the first time that PhilHealth has made the headlines (for all the wrong reasons).

Also read:
Here’s Why You’re Paying More in PhilHealth Contributions in 2020
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PhilHealth's Filthy Secrets: "Office Nightclub," "Mafia," + More

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Here's a timeline of some of the messes that the agency was involved in before 2020:

2019

In June 2019, there were claims that PhilHealth made "overpayments" of up to P154 billion for patients supposedly stricken with pneumonia from 2010 to 2018—with up to 757,000 claimants just in 2018. The Philippine Star reported that PhilHealth paid out P12.69 billion for the hospital bills of 810,000 patients stricken with pneumonia in 2018. According to an article by the Inquirer, these numbers are staggering, considering that there was no pneumonia outbreak declared by the Department of Health.

But PhilHealth denied these allegations. "The article is only half of the story. It must be remembered that there is no health insurance system in the entire world that is fraud-free," Dr. Roy B. Ferrer, PhilHealth Acting President and CEO said in a statement by the health agency released on June 10, 2019.

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In the same month, President Rodrigo Duterte ordered PhilHealth executives to submit their courtesy resignations after reports that the health agency allegedly paid out billions of pesos for dialysis of non-existent or dead patients. These allegations surfaced after a former employee of WellMed Dialysis Center in Quezon City revealed a "ghost dialysis" scheme for fraudulent insurance claims.

2015

Former Health Secretary Janette Garin allegedly diverted P10.6 billion of the PhilHealth budget to fund barangay health stations, rural health units, national government hospitals, and mobile dental vehicles. The use of the fund "on uncompleted projects for political campaign purposes" created a huge loss for the agency, according to a panel report during the Senate Blue Ribbon Committee hearing on Tuesday, August 25, 2020.

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"Dapat mapunta 'yang pera sa PhilHealth, binawi niya, inilagay niya sa isang project na hindi naman inaasinta ng gobyerno, so technical malversation," Senator Richard Gordon said in an interview. The funds were supposed to go towards the PhilHealth premiums of senior citizens.

2014

Former PhilHealth employee Bernadith Ipanag was supposedly terminated from work in 2014 after revealing the alleged anomaly at the agency's regional office in Davao City. The reason for dismissal was for allegedly incurring absences, which was non-disciplinary. The issuance of public notice from PhilHealth was also questioned since Civil Service Commission guidelines say that such an action can be done only when the sanction is disciplinary in nature.

2007

In a congressional hearing in 2007, PhilHealth Vice President for Health Finance Policy Dr. Madeleine Valera revealed that the health agency lost as much as P4 billion because of fraudulent claims. 

A lot of stories surfaced, one of which was a 2006 incident involving an eye doctor in Iloilo who claimed up to P16 million from PhilHealth. This was supposedly for professional fees for 2,017 eye surgeries performed in one year. The incident was also mentioned in a 2019 op-ed by Charlie Manalo for Manila Standard.

Iloilo-based daily The News Today aired the side of Dr. Miguel Sarabia, who was alarmed by the possible implications of the controversy for him and his medical collegues in Western Visayas. "Of course, we charge PhilHealth with our doctor's fee. What are we slaves? We have families to feed. Have houses to build and children to educate. We are completely mis-understood," the doctor said about news that Bacolod City-based eye specialists Dr. Nonito Avecilla and Dr. Leopoldo Cuaycong were involved in irregularities in insurance claims for cataract surgeries. Sarabia, Avecilla, Cuaycong, and Danilo Guanzon faced administrative cases filed by PhilHealth in 2007 for allegedly padding claims.

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Another controversy involved a hospital in Davao City where patients pretended to be PhilHealth members to get insurance claims.

Fast Forward to 2021

On August 4, PhilHealth Acting Senior Vice President Nerissa Santiago told the Senate Committee on the Whole that PhilHealth will soon lose funds because of the ongoing pandemic. "It will be in 2021 that we will run into deficit. There will be no more reserve fund by 2021," she said. The agency is expecting to lose up to P90 billion in 2020, and another P147 billion in 2021. 

PhilHealth in January 2020 said that members should expect an annual increase in contributions until 2025. Premium rate in 2021 goes up to 3.50%.

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