House probe sought into P59.6-B unsettled hospital dues by PhilHealth

A senior lawmaker is pushing for an investigation of P59.6 billion worth of hospital reimbursement claims that the Philippine Health Insurance Corp. (PhilHealth) has failed to pay since 2017 up to last year.

Cagayan de Oro Rep. Rufus Rodriguez filed House Resolution 2173 to launch an in-depth congressional probe into the accumulation of the denied and returned hospital claims by the state insurer, which was put to the spotlight during the hearing of the House committee on health on Wednesday. 

PhilHelath senior vice president Renato Limsiaco informed lawmakers that there were 483,000 denied claims amounting to P4.7 billion in 2024 alone. Around three million claims totaling P32.4 billion, meanwhile, were rejected from 2018 to 2023. 

Limsiaco also disclosed that PhilHealth had cash on hand amounting to P492 billion as of the year-end of 2024. 

Rodriguez asserted that PhilHealth has no particular reason to incur the dues taking into account that it has massive funds to settle the same. 

“In spite of the P759 billion in accessible funds, P59 billion is left unpaid to the detriment of the hospitals and Philhealth members served by said hospitals,” Rodriguez lamented. 

The seasoned lawmaker said PhilHealth has P150 billion in surplus reserve funds, P203 billion in estimated premium collection for 2025, P80 billion in unfunded allotment of 2023 and 2024, (and) P21 billion in unreleased appropriations.

“It was also mentioned that PhilHealth has around P280 billion in reserves and P25 billion investment income in 2024. All this would total P759 billion, which could be accessed to pay for valid claims of hospitals,” he argued.

The Department of Health reported that the majority of the claims were denied because hospitals failed to file them within 60 days as mandated by law.

The looming investigation, according to Rodriguez, will set up measures how to put an end to this practice for them to be paid by Philhealth.

“These non-payments of claims have resulted in the partial closure of some medical services of hospitals, and in some cases the full closure of hospitals,” the resolution reads.

“Workers had to be terminated due to the partial or full closure of hospitals, which is likewise detrimental to Philhealth members who need medical care,” the Mindanaoan solon added.

PhilHealth has been the subject of controversies and corruption allegations over the years.

Last year, the Supreme Court upheld the notices of disallowance issued by the Commission on Audit on Philhealth’s grant of new allowances for its employees totaling P43.8 million without the approval of then President Gloria Macapagal-Arroyo in 2010.

This year, Congress allocated zero subsidy to PhilHealth, citing the need to first exhaust its remaining huge reserve funds, reportedly amounting to a whopping P600 billion. 

Initially, PhilHealth was supposed to receive more than a P74 billion subsidy from the government but was removed by the bicameral committee due to its alleged history of slow and inefficient budget utilization, notwithstanding substantial excess funds. 

The subsidy reportedly includes over P50 billion for premiums for the unemployed and P20 billion for additional benefits.