PhilHealth flagged over delay in going after fraud cases

In a statement Thursday, the Task Force PhilHealth under the Department of Justice (DOJ) said it has flagged the low and slow rate of prosecution of cases by PhilHealth’s legal office. (File Photo: Philippine Health Insurance Corporation/Facebook)

MANILA – The task force investigating anomalies hounding the Philippine Health Insurance Corp. (PhilHealth) called out the state firm’s alleged ‘foot-dragging’ in going after thousands of fraud cases involving its employees and some healthcare institutions (HCIs).

In a statement Thursday, the Task Force PhilHealth under the Department of Justice (DOJ) said it has flagged the low and slow rate of prosecution of cases by PhilHealth’s legal office.

“In its hearing conducted yesterday (Wednesday), the Task Force noted the thousands of cases against erring PhilHealth employees and health care institutions (HCIs) which remain unfiled. Resigned Senior Vice President for the Legal Sector Atty. Rodolfo del Rosario, Jr. confirmed that while there are thousands of administrative cases against PhilHealth employees in the corporation’s case inventory, only 70 cases have been ‘processed,’ and only 50 have resulted in the issuance of formal charges against employees,” Justice Undersecretary and spokesman Markk Perete said.

The DOJ said one notable case against PhilHealth employees involves claims worth around PHP2.1 billion.

Del Rosario, in his appearance before the fact-finding body, reported that there are around 1,700 cases in PhilHealth’s case inventory involving HCIs.

He said his office has reviewed and endorsed 1,003 cases for filing of criminal complaints by the regional offices. He admitted that only 11 cases have been filed to date.

Losses related to cases involving HCIs including fraudulent claims is estimated at around PHP4.7 billion.

The Governance Commission for Government-Owned and -Controlled Corporations (GCG) has previously given the PhilHealth legal sector a zero rating in its 2017 and 2018 evaluations because of delays in the filing of cases.

Pressed to account for the Legal Sector’s performance, del Rosario said the management policy favored settlement over the prosecution of cases so as not to dampen esprit de corps.

He also noted alleged limitations in resources of regional offices that prevent them from promptly filing criminal complaints against HCIs.

The Task Force earlier created a composite team that will investigate PhilHealth’s Legal Department.

The team will, among others, audit and validate the case inventory of PhilHealth, and recommend, if warranted, the start of administrative, civil and/or criminal action against the corporation’s employees and HCIs.

Justice Secretary Menardo Guevarra, meanwhile, expressed hope that the task force will be able to file cases against those behind the widespread fraud within the state firm.

“At the end of this investigation, we hope to be able to build up enough cases against persons responsible for the PhilHealth mess, whether or not they continue to be in PhilHealth’s employ,” he told reporters.