MANILA, Philippines — Administrative and criminal complaints have been recommended against some Philippine Health Insurance Corp. (PhilHealth) officials over alleged fraudulent membership enrollment and fraudulent benefit claims at the state insurer’s Regional Office (RO) I.
According to a task force created to probe corruption issues hounding PhilHealth, it has endorsed the filing of complaints against 25 incumbent and former PhilHealth officials, mostly from its office in the Ilocos Region,
“As part of its continuing work, Task Force PhilHealth has officially endorsed to the Office of the Ombudsman, the Report of the Presidential Anti-Corruption Commission (PACC), containing its investigation on alleged fraudulent membership enrollment and fraudulent benefit claims done at [PhilHealth] Regional Office I,” the Task Force PhilHealth said in a statement on Tuesday.
“In the Report, criminal and administrative complaints are recommended to be filed against twenty-five (25) incumbent and separated officials of PhilHealth, majority of whom are from the Regional Office,” it added.
The task force claimed PACC’s investigation uncovered a scheme where a fake membership account, “Pamela del Rosario”, was created with PhilHealth RO-I and made to appear to have made contributions and had 27 claims under it.
Department of Justice Undersecretary Neil Bainto said the 27 claims amounted to around P1.1 million.
“Investigations revealed that a fake account was created at PhilHealth Regional Office I under the name ‘Pamela Del Rosario’ and contributions were retroactively applied and ante-dated,” Task Force PhilHealth said. “Twenty-seven (27) fraudulent claims were then made under this account.”
“The Report also recommended charging PhilHealth officials and employees tasked to investigate such alleged fraudulent scheme and their consequent failure to properly prosecute those involved in the incident,” it added.
The respondents, whose names were not yet released, may face complaints over allegeld violations of various laws, namely:
- falsification by a public officer under Article 171 of the Revised Penal Code (RPC);
- malversation under Article 217 of the RPC;
- usurpation of authority under Article 177 of the RPC;
- sections of Republic Act No. 3019 or the Anti-Graft and Corrupt Practices Act;
- sections of R.A. No. 7875 or the National Health Insurance Act of 1995, as amended by
- R.A. 9241 and R.A. 10606;
- administrative charges of grave misconduct and conduct prejudicial to the best interest of the service
Fake receipts
Bainto further explained that despite the bogus “claims,” no hospital or hospital officials appear to be liable for conspiracy because the claims were supported by fake receipts.
“Based on the investigation, it appears that the claims submitted by this Pamela Del Rosario, and the payments made to her, were supported by fake receipts. At this point, there is no showing that the Hospital involved/Hospital officials were complicit in the fraudulent scheme,” he told reporters.
The creation of fake membership accounts within PhilHealth is only one of several corruption allegations thrown against the government-controlled corporation as high-ranking PhilHealth officials are also accused of bloating the prices of information technology items it procured.
Whistleblowers who resigned from PhilHealth due to alleged massive corruption claimed that a mafia within the state health insurance firm has already pocketed around P15 billion.
READ: ‘PhilHealth mafia’ pocketed P15-B worth of funds, says ex-anti-fraud exec
READ: Multi-million-peso worth of laptops? PhilHealth exec highlights anomalies
On Monday, the National Bureau of Investigation filed graft and administrative charges against PhilHealth officials for allowing the release of P33.8 million of interim reimbursement mechanism (IRM) funds to a dialysis facility.
READ: NBI sues Morales, other PhilHealth execs over irregular fund release
IRM funds should only be used for fortuitous or unforeseen events like the COVID-19 pandemic — something that dialysis clinics do not address.