Controversy
Philippine Senate Majority Leader Juan Miguel Zubiri alleged fraud by several hospitals in 2013, identifying cases that took millions of pesos from Philhealth.[13] The state failed to prosecute doctors, private and public hospitals, and public officials. AFP Medical Center, St. Luke's Hospital, Philippine Orthopedic Hospital, University of Santo Tomas Hospital, East Avenue Medical Center, Cardinal Santos Medical Center, Medical City, National Kidney and Transplant Institute, and General Santos Doctors Hospital (GSDH) were investigated for health-insurance fraud.[14] In Iloilo, eye-doctor claims for 2,071 operations in 2006 (amounting to PHP16 million in professional fees) were also investigated. A hospital in Davao City noted that a janitor who was not a PhilHealth member had been lying in bed to claim benefits as a PhilHealth patient.[15] In 2006, PhilHealth revoked the accreditation of Sara Medical Clinic in Midsayap for admitting non-existent patients.[15]
A lawmaker learned in 2018 that Philhealth interim president Celestina Dela Serna lived in a hotel for P3,800 per night for at least a year instead of renting a condominium or apartment in Metro Manila. Negros Oriental representative Arnulfo Teves said that he and House Speaker Pantaleon Alvarez spoke with Dela Serna during a House of Representatives event, and were surprised by her extravagant lifestyle. "She admitted to staying in the hotel for one year or more ... charged to Philhealth and she said she thought it was okay, that's why she did it," he said. Teves added that Dela Serna told him and Alvarez that she stayed at Legend Villas, where rooms cost at least ₱3,800 per night.[16]
A Change.org petition was circulated by a group of overseas Filipino workers (OFWs) to scrap the agency's directive to increase the mandatory premium to three percent of monthly salaries.[17] The petition referred to PhilHealth Circular 2020-0014[18] dated April 2, 2020, when OFW salaries were affected by the COVID-19 pandemic.[17] President Rodrigo Duterte suspended the collections after a backlash, and the agency considered a longer payment period.[19]
On July 24, 2020, anti-fraud legal officer Thorrsson Montes Keith resigned due to corruption and irregularities in the agency.[20] His salary and hazard pay had been delayed, and his resignation would be effective August 31. According to presidential spokesman Harry Roque, the government would investigate alleged overpricing of a proposed IT system costing about ₱2 billion.[20][21][22][23]
On August 25, 2021, Senator Richard Gordon presented a Senate committee report of its 2019 investigation of alleged fraud and corruption in the state-run health insurer. Video footage in the report included a PhilHealth regional vice president receiving a lap dance.[24] According to Thorrsson Montes Keith, PhilHealth officials misappropriated at least ₱15 billion in overpriced IT projects, "ghost claims", and the misuse of COVID-19 funds.[25] In Senate testimony, Keith compared PhilHealth officials to a "mafia" or "syndicate".[26]
The following day, PhilHealth president and CEO Ricardo Morales said that he would resign.[27][28] PhilHealth Senior Vice President for the Legal Sector Rodolfo del Rosario Jr. also resigned.[29]
In September 2023, Philhealth was hacked with Medusa ransomware. Employee and other internal data was breached, with a possibility of member data. The hackers demanded $300,000 (about ₱17 million).[30] Philhealth refused to pay the ransom, and the hacker group posted the stolen data on the dark web; data included hospital billing, internal memos, and identification documents. Philhealth said that member data, on a separate server, was not compromised. The National Privacy Commission began investigating the true extent of the leak.[31]
On August 2, 2024, Senator Koko Pimentel and a public-health advocacy group filed certiorari and a writ of prohibition with a restraining order to stop the transfer of ₱89.9 billion in PhilHealth funds to the national budget. The petitioners challenged the constitutionality of Department of Finance Circular 003-2024. Secretary Ralph Recto defended the return of unused government subsidies to the national treasury, saying that the circular implements a congressional order under Section XLIII (1)(d) Republic Act No. 11975 (the General Appropriations Act 2024).[32] In 2025, the DOH returned ₱60 billion in surplus funds to PhilHealth to strengthen its universal-healthcare program.[33]
