PhilHealth strengthens member welfare amid Ombudsman flagging

State insurer PhilHealth is strengthening audits and member protection measures following fresh allegations of fraudulent billing schemes involving private hospitals.

“PhilHealth thanks the Ombudsman Remulla for amplifying the concerns of Filipino patients. His voice adds to a conversation PhilHealth has long been committed to — ensuring every member receives the full benefit they deserve,” it said in a Tuesday statement.

“As part of our ongoing monitoring efforts, PhilHealth is looking into reported discrepancies between what patients are told about their coverage and what providers submit in their claims,” the agency added.

PhilHealth added it had disbursed P300.45 billion in benefits in the past year, an 81.72-percent increase from the previous year, reflecting expanded coverage and higher utilization under Universal Health Care.

“Every peso represents a family we were able to stand beside as their partners in health,” the agency said, adding that it will continue to expand benefits for Filipino families.

The move comes as Ombudsman Jesus Crispin Remulla alleged a widespread hospital “kickback” scheme, where some patients were allegedly charged out-of-pocket despite being covered, while hospitals later claimed reimbursements from PhilHealth and diverted excess funds. Reports also flagged bloated billing and fraudulent claims in some private facilities.

PhilHealth acknowledged concerns over discrepancies in billing and said it is stepping up oversight.

“We are reinforcing our auditing systems, deepening coordination with oversight bodies and healthcare providers, and ensuring that our members always receive accurate, transparent information about their benefits,” it said.

The agency welcomed the involvement of the Ombudsman, saying external scrutiny helps strengthen accountability and protect patients.

PhilHealth also emphasized that members have the right to full benefits under the law.

To avoid overbilling or misinformation, the agency urged patients to verify coverage with hospital staff, request itemized bills, and consult PhilHealth CARES (PCARES) representatives. It also encouraged the use of its mobile app to check case rates.

PhilHealth stressed that public feedback is critical in improving the system, noting that member reports help guide ongoing reviews and reforms.

“PhilHealth remains committed to working with all partners, government, providers, and patients, toward a healthcare system that is transparent, responsive, and truly protective of every Filipino.”