PhilHealth allowed thousands of fraud cases to go unchecked – DOJ

Lian Buan
There was a management policy to prefer settlement over prosecution so as not to dampen morale

The Department of Justice (DOJ) said on Thursday, August 27, that the Philippine Health Insurance Corporation (PhilHealth) allowed thousands of fraud cases to go unchecked, most of them remaining within the internal legal mechanisms of the agency where officials preferred settlement rather than filing charges.

“While there are thousands of administrative cases against PhilHealth employees in the corporation’s case inventory, only seventy (70) cases have been ‘processed,’ and only fifty (50) have resulted in the issuance of formal charges against employees,” Justice Undersecretary Markk Perete told reporters Thursday.

Perete said this was revealed to the the DOJ’s task force by resigned Philhealth legal senior vice president Rodolfo del Rosario Jr. Del Rosario said the fraud cases were both against employees and healthcare institutions (HCIs).

Del Rosario said that, of the 1,700 cases reviewed by his unit against HCIs, they had endorsed 1,300 for the filing of criminal complaints. However, to this day, there are only 11 cases filed.

The cases against HCIs alone amount to P4.7 billion in fraudulent claims. There was one single case against employees that involved P2.1 billion, said Perete.

“The Governance Commission for Government-Owned and -Controlled Corporations has previously given the PhilHealth Legal Sector zero rating in its 2017 and 2018 evaluations because of delays in the filing of cases,” said Perete.

Del Rosario said there was a “management policy that favored settlement over prosecution of cases so as not to dampen esprit de corps.”

“[Del Rosario] also noted alleged limitations in resources of regional offices that prevent them from promptly filing criminal complaints against HCIs,” said Perete.

The DOJ-led task force will audit and validate the fraud cases and, if warranted, lead the filing of criminal, civil, and administrative complaints.

Del Rosario is allegedly among the 4 members of the so-called PhilHealth mafia who ran fraudulent schemes and might have misspent or pocketed some P15 billion, according to a resigned anti-fraud officer.

He and 12 other PhilHealth officials have been preventively suspended by the Ombudsman now that the agency is under investigation for corruption. Del Rosario agreed to sign a bank secrecy waiver, allowing the Anti-Money Laundering Council to look into his bank transactions.

He tendered his resignation effective August 24. – with a report from Mara Cepeda/

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Lian Buan

Lian Buan covers justice and corruption for Rappler. She is interested in decisions, pleadings, audits, contracts, and other documents that establish a trail. If you have leads, email or tweet @lianbuan.