1
EIGHTEENTH CONGRESS OF THE 
 
) 
REPUBLIC OF THE PHILIPPINES 
 
) 
Second Regular Session 
 
 
 
) 
 
 
S E N A T E 
S. B. No. _____ 
___________________________________________________________ 
 
Introduced by Senator SONNY ANGARA 
___________________________________________________________ 
 
AN ACT  
AMENDING SECTION 18 OF REPUBLIC ACT NO. 11223, OTHERWISE KNOWN 
AS THE UNIVERSAL HEALTH CARE ACT 
 
EXPLANATORY NOTE 
 
 
In August, the Senate Committee of the Whole conducted three (3) public 
hearings to investigate allegations of rampant corruption, incompetence, and 
inefficiency within the Philippine Health Insurance Corporation (PhilHealth) with the end 
in view of reforming the coXntr\¶s national health insXrance program to be more 
responsible and accountable with the funds provided by the public. This comes during 
the time of the COVID-19 pandemic where a transparent and easily accessible health 
insurance is badly needed to assist its members.  
 
Part of the discussion of the Committee was the alleged overpayment of 
PhilHealth to several health care providers (HCPs)/health care institutions (HCIs) 
through its Interim Reimbursement Mechanism (IRM). Meanwhile, some hospitals who 
are in actual need of reimbursements from the Corporation have been seemingly 
neglected. For instance, the Committee of the Whole discovered that PhilHealth hastily 
released funds to a specific cluster of dialysis centers while various hospitals have 
reached out to the Committee and reported that they have not received IRM funds.  
Furthermore, the practice of overpayment and ³upcasing´ through the All Case 
Rate (ACR) scheme has long been an issue of PhilHealth as it endangers the financial 
viability and actuarial life of the Corporation and rewards erring HCPs/HCIs and corrupt 
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11:15 a.m.
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PhilHealth employees. While the All Case Rate scheme ± which should have been 
subjected to constant computation and evaluation ± is recognized as a practice globally, 
it has been abused by some individuals as evidenced by allegations in the last few 
years.  
 
With the enactment of Republic Act No. 11223 or the Universal Health Care 
(UHC) Act, Filipinos are expecting that our health care system will be more responsive 
in the coming years. More importantly, the public is also expecting that PhilHealth ± 
being the national health insurance provider ± will be more fiscally prudent as to how it 
manages and processes the reimbursement of medical claims made by HCPs and HCIs.  
 
Hence, the proposed measure ± Zhich is part of this representation¶s 
recommendation to the Committee of the Whole Report ± will amend the Universal 
Health Care Act and add another layer of accountability to the release of reimbursement 
for medical claims as HCPs, HCIs, and PhilHealth will be mandated to execute a sworn 
undertaking that all medical claims and reimbursements are true and correct. This shall, 
in turn, be part of PhilHealth¶s sXbmission to the Commission on AXdit (COA). 
 
With the numerous allegations of corrupt practices within PhilHealth, especially 
during a worldwide health crisis, it is just to give the public assurance that their 
contributions and the subsidy of the national government are spent responsibly and 
judiciously. In view of the foregoing, the immediate passage of the bill is earnestly 
sought. 
 
 
 
SONNY ANGARA 
 
 
 
 
 
 
 
 


 
1 
EIGHTEENTH CONGRESS OF THE 
 
) 
REPUBLIC OF THE PHILIPPINES 
 
) 
Second Regular Session 
 
 
 
) 
 
 
S E N A T E 
S. B. No. _____ 
___________________________________________________________ 
 
Introduced by Senator SONNY ANGARA 
___________________________________________________________ 
 
AN ACT  
AMENDING SECTION 18 OF REPUBLIC ACT NO. 11223, OTHERWISE KNOWN 
AS THE UNIVERSAL HEALTH CARE ACT 
 
Be it enacted by the Senate and House of Representative of the Philippines in Congress 
assembled: 
 
SECTION 1. Section 18 of Republic Act No. 11223 or the Universal Health Care Act 
1 
is hereby amended to read as follows: 
2 
 
 
“Section 18. Individual-based Health Services. –  
3 
a) x x x. 
4 
b) PhilHealth shall endeavor to shift to paying providers using 
5 
performance-driven, close-end, prospective payments based on 
6 
disease or diagnosis related groupings and validated costing 
7 
methodologies 
and 
without 
differentiating 
facility 
and 
8 
professional fees; develop differential payment schemes that give 
9 
due consideration to service quality, efficiency and equity; and 
10 
institute strong surveillance and audit mechanisms to ensure 
11 
networks’ compliance to contractual obligations: PROVIDED, 
12 
THAT HEALTH CARE INSTITUTIONS/HEALTH CARE 
13 
PROVIDERS ARE MANDATED TO EXECUTE A SWORN 
14 
UNDERTAKING THAT THE MEDICAL CLAIMS SUBMITTED 
15 
TO PHILHEALTH FOR REIMBURSEMENT ARE CERTIFIED 
16 
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TRUE AND CORRECT: PROVIDED FURTHER, THAT 
1 
PHILHEALTH, FOR ITS PART, SHALL LIKEWISE ISSUE A 
2 
CERTIFICATION UNDER OATH THAT A THOROUGH 
3 
REVIEW OF THE MEDICAL CLAIM WAS DONE AND THAT 
4 
THE ACTUAL REIMBURSEMENT PAID TO THE HEALTH 
5 
CARE INSTITUTIONS/HEALTH CARE PROVIDERS ARE 
6 
TRUE AND CORRECT: PROVIDED FINALLY, THAT THIS 
7 
DOCUMENT SHOULD FORM PART OF PHILHEALTH’S 
8 
SUBMISSION TO THE COMMISSION ON AUDIT (COA).” 
9 
SEC. 2. Separability Clause. – If any provision of this Act is declared invalid or 
10 
unconstitutional, the other provisions not affected thereby shall continue to be in full 
11 
force and effect.  
12 
SEC. 3. Repealing Clause. – All other laws, decrees, orders, rules and regulations, 
13 
other issuances, or parts thereof inconsistent with the provisions of this Act are hereby 
14 
repealed or modified accordingly. 
15 
SEC. 4. Effectivity. – This Act shall take effect fifteen (15) days after its publication 
16 
in the Official Gazette or in a newspaper of general circulation.  
17 
 
Approved.