DOJ endorses graft raps vs PhilHealth regional officers to Ombudsman

January 12, 2021

MANILA, Philippines — The Department of Justice-led task force investigation into the Philippine Health Insurance Corp. has endorsed complaint against the state insurer’s officers in the Ilocos region over fraudulent claims.

DOJ Assistant Secretary Neal Bainto on Tuesday said Task Force PhilHealth has endorsed the report of the Presidential Anti-Corruption Commission recommending administrative and criminal complaints against PhilHealth regional officers to the anti-graft office.

The report contains the PACC’s investigation into “fraudulent membership enrolment and fraudulent benefit claims done at PhilHealth Regional Office I,” Bainto said.

The complaint named 25 incumbent and former officials and employees of PhilHealth Region I. The complaint accused them of committing the following:

  • Falsification by public officer under Article 171 of Revised Penal Code
  • Malversation article 217
  • Usurpation of Authority under Article 177
  • violation of Anti-Graft and Corrupt Practices Act under Republic Act 3019
  • violation of National Health Insurance Act of 1995 under RA 7875
  • Administrative liabilities for grave misconduct and conduct prejudicial to the best of service

“Investigations revealed that a fake account was created at PhilHealth Regional Office I under the name ‘Pamela Del Rosario’ and contributes were retroactively applied and ante-dated,” Bainto said.

Investigation also showed that 27 fraudulent claims were then made under this account, amounting to P1.1 million.

While the claims under the fake account were backed by fraudulent receipts, Bainto said “at this point, there is no showing that the hospital involved/hospital officials were complicit in the fraudulent scheme.”

The DOJ official said the Task Force PhilHealth discussed and deliberated on the alleged fake account several times in its meetings. “PACC was the one who did the investigation. The PACC”s report was also validated by the DOJ and we found it sufficient to be filed before the Ombudsman,” Bainto added.

Bainto also said that the PACC report also recommended filing complaints against PhilHealth officials and employees tasked to investigate such alleged fraudulent scheme and “their consequent failure to properly prosecute those involved in the incident.”

He said the DOJ is withholding names of the respondents for now until they a subpoena has been issued against them.

PACC is a member of the inter-agency panel formed to investigate the state insurer, after PhilHealth’s  former anti-fraud legal officer Thorrsson Keith alleged that its executives stole P15 billion from its funds through fraudulent schemes.

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