Probe of P59.6-B PhilHealth mess urged

A senior lawmaker is pushing for an investigation into the P59.6-billion worth of hospital reimbursement claims that the Philippine Health Insurance Corp. (PhilHealth) failed to pay from 2017 to 2024.

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 under the spotlight during the hearing of the House committee on health last Wednesday.

PhilHealth 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 yearend 2024.

Rodriguez asserted that there was no particular reason for PhilHealth to incur the dues taking into account its massive funds.

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

The seasoned lawmaker said PhilHealth has P150 billion in surplus reserve funds, P203 billion in estimated premium collections for 2025, P80 billion in unfunded allotments in 2023 and 2024, and P21 billion in unreleased appropriations.

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

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

The looming investigation, according to Rodriguez, will set up measures to put an end to this practice of Philhealth.

“This non-payment of claims resulted in the partial closure of some hospital services, and in some cases the full closure of hospitals,” the resolution read.

“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.