PhilHealth vs. COA: Disallowed Benefits Case
PhilHealth vs. COA: Disallowed Benefits Case
$)Upreme Qtourt
;fffilanila
EN BANC
GESMUNDO, C.J.,
LEONEN,
- versus - CAGUIOA,
HERNANDO,
LAZARO-JAVIER,
INTING,
ZALAMEDA,
COMMISSION ON AUDIT, LOPEZ,M.
MICHAEL G. AGUINALDO, GAERLAN,
CHAIRPERSON, ROSARIO,
Respondent. LOPEZ, J.
DIMAAMPAO,
MARQUEZ,
KHO, JR., and
SINGH,JJ
Promulgated:
RESOLUTION
SINGH, J.:
This resolves the Special Civil Action for certiorari 1 (Petition) under
Rule 65, in relation to Rule 64, with prayer for Temporary Restraining Order
(TRO) and Writ of Preliminary Injunction (WPI) filed by petitioner
Philippine Health Insurance Corporation (PhilHealth) assailing the
December 20, 2017 Decision No. 2017-4222 of the Commission on Audit
1
Rollo,, pp. 3-37.
2
Id. at 38-47. The December 20, 2017, Decision No.2017-422 was rendered by Chairperson Michael G.
Aguinaldo, Commissioner Jose A. Fabia, and Commissioner Isabei D. Agito of the Commission on
Audit, Commonwealth, Avenue, Quezon City.
Resolution 2 G.R. No. 249061
(COA) Commission Proper (CP) and its September 24, 2018 Resolution,3.
The COA CP affirmed with modification the June 10, 2014 Decision4 of the
COA Regional Office No. V Office of the Regional Director (COA ROV),
which affirmed the 19 Notices of Disallowance (ND) addressed to the
PhilHealth Regional Office No. V (ROV) covering the payment of various
benefits and allowances to job order contractors and project-based contractors
in the total amount of PHP 4,146,213.85.
The Facts
Between 2009 and 2011, PhilHealth ROV granted to its job order
contractors and project-based contractors various benefits, which include: (1)
transportation allowance; (2) sustenance gift; (3) nominal gift; (4)
productivity enhancement incentive; (5) special events gift; (6) project
completion incentive; (7) efficiency gift; (8) alleviation gift; (9) labor
management relations gift; (10) gratuity gift; and (11) contractors gift, the
combined amounts of which is equivalent PHP 4,146,213.85.
3
Id. at.48. The COA Commission Proper En Banc issued on September 27, 2018, a Resolution in COA
CP Case No. 2014-572, denying PhilHealth'sMotion of Resolution.
4
Id. at 145-155. The June 10, 2014, COA ROY Decision No. 2014-C-024 was penned by Director Eden
T. Rafanan of the office of the Regional Director, COA Regional office No. V ofBawis, Legaspi City.
5
Id. at 71-74.
6
Id. at 75-77.
7
Id. at 78-79.
8
Id. at 80-81.
9 • Id. at 82-83.
10
Id. at 84-85.
11
Id. at 86-87.
12
Id. at 88-90.
Resolution 3 G.R. No. 249061
The benefits in the rest of the assailed NDs were disallowed for lack of
legal basis. 25
Other than the payees, the persons determined to be liable in the various
transactions are outlined in the table below:
13
Id. at 93-94.
14
Id. at 95-96.
15
Id. at 97-99.
16
Id. at 100-102.
17
Id. at 103-105.
18
Id. at 106-107.
19
Id. at 108-109.
20
Id. at 110-111.
21
Id. at 112-113.
22
Id. at 114-115.
23
Id. at 91-92.
24
Id. at 71 & 103.
25
Id. at 146-151.
Resolution 4 G.R. No. 249061
11-036 (10)
Approved the payment 11-037 (10)
signing on behalf of 11-038
Veronica T. Mateum28 11-039
11-041
11-042
11-043
11-044
11-048
Darlene L. Nuyles, Certified that the 11-027(10)
CSIO/Acting AO IV expense 1s necessary, 11-028(10)
lawful and authorized 11-030 (09)
under her direct 11-031 (10)
superv1s1on 11-032 (10)
11-033 (09)
11-037 (10)
11-039
11-040
11-041
11-038
Rosie B. Saldivar, Certified that the 11-027 (10)
Human Resources expenses are necessary, 11-028 (10)
Management III lawful and authorized
under her direct
..
superv1s10n, s1gmng on
behalf of Darlene L.
Nurles
Shirley S. Victoria, Certified that adequate 11-027(10)
Fiscal Controller III fund 1s available, 11-028 (10)
expenditure proper and 11-035 (10)
supported by 11-038
documents, and signing 11-039
on behalf of Grazielle 11-042
R. Castillo29
David I. Escandor Division Chief, and 11-027 (10)
signing on behalf of 11-037 (10)
Veronica T. Mateum30
PhilHealth ROY appealed the NDs to the COA ROY arguing that the
PhilHealth has fiscal autonomy under Republic Act No. 7875, or the National
Health Insurance Act of 1995,31 including the explicit power to fix the
compensation of its personnel. 32 Furthermore, PhilHealth ROY submitted
that PhilHealth personnel who received the questioned benefits did so in good
faith and thus should not be held liable to refund of the same. 33 Finally,
PhilHealth ROY invoked the principle of equity claiming that similar benefits
were granted in other PhilHealth regional offices without disallowance. 34
In its Decision No. 2014-C-024, dated June 10, 2014, the COA ROY
1
The COA ROY emphasized that the payees of the assailed NDs were
job order contractors and project-based contractors who are not considered to
have any employee-employer relationship with PhilHealth. Thus, the grant of
various incentives, benefits, and transportation allowances to them lacked
legal bases and violate the law on government disbursements. 35
Also, COA ROV did not lend credence to the claim of good faith by
PhilHealth ROV, as the latter persisted in granting such benefits despite
previous similar disallowances. The COA ROV, however, declined to pass
upon the issue of equity, since it is only an administrative body bound by the
letter of the law, unlike regular courts which are courts of both justice and
equity. 36
However, the COA CP affirmed the assailed NDs in all other respects,
emphasizing that the corporate powers of PhilHealth to determine the
compensation of its officers and employees are limited by law, the policies of
33
Id. at 137-142.
34
Rollo, pp. 142-143.
35
Id. at 152-154.
36
Id. at 154.
37
Id. at 156-174.
38
Id. at 38-47.
39 Id. at 45-46.
Resolution 7 G.R. No. 249061
the Office of the President (OP) and the Department of Budget and
Management (DBM). 40 The COA CP also ruled that the approving and
certifying officers remain solidarily liable (with the members of PhilHeath's
Board of Directors) for the disallowances. 41
The Audit Team Leader and the Supervising Auditor, PHIC RO No.
V, are hereby directed to issue a Supplemental ND to include as persons
liable, the PHIC Board of Directors, who issued and approved the Board
Resolutions granting the disallowed benefits and allowances. 42 (Emphasis
in the original)
In its Resolution, dated September 27, 2018, the COA CP denied said
Motion for Reconsideration. Undaunted PhilHealth ROV filed this Petition
before the Court to assail the Decision of the COA CP.
40
Id. at41--44.
41
Id. at 44--45.
42
Id. at 46.
43
Id. at 50-58.
44 Id. at 51-52.
Resolution 8 G.R. No. 249061
In its Resolution, 49 dated March 28, 2023, the Court required the parties
to move in the premises within l O days from notice. Respondents, complied
with the Resolution through their Compliance and Manifestation,50 dated June
20, 2023. Similarly, PhilHealth filed its Compliance, 51 dated July 10, 2023,
informing the Court that it has submitted a letter, 52 dated June 14, 2023,
addressed to President Ferdinand R. Marcos, Jr. requesting for post facto
presidential approval of the allowances, benefits, and incentives (ABls)
granted to PhilHealth officers and employees but were subsequently
disallowed. 53 PhilHealth averred that the request for the President's postfacto
approval would, among other things, evince and uphold the clear intent to
provide the ABis to PhilHealth employees. 54
The Issue
45
/d.atl92-193.
46
Id. at201-242.
47 Id. at 243-244.
48
Id.at251-264.
49
Id. at 268-269.
50 Id. at 270---277.
51 Id. at 286-289.
52
Id.at290-29I.
53
Id. at 291.
54
Id. at 287.
55
Social Security System v. Commission on Audit, G.R. No. 231391, June 22, 2021 [Per J. Inting, En Banc].
at 5--6. This pinpoint citation tefen to the copy of the Decision uploaded to the S u p r e m 7
Resolution 9 G.R. No. 249061
'
Here, the Petition failed to prove that the COA committed grave abuse
of discretion in affirming the assailed NDs. Nevertheless, the Court must
clarify the liability of the individuals identified in the NDs in light of
jurisprudential guidelines.
56
818 Phil. 380(2017) [Per J. Bersamin, En Banc].
57
Id. at 389-390.
58
Phi/Health v. Commission on Audit, G.R. No. 258100, September 27, 2022 [Per J. Zalameda, En Banc].
at 6. This pinpoint citation refers to the copy of the Decision uploaded to the Supreme Court website.
59
Section 16. Powers and Functions. The Corporation shall have the following powers and functions: '
(n) to organize its office, fix the compensation off,] and appoint personnel as may be deemed necessary
and upon the recommendation of the president of the Corporation.
60
Rollo, pp. 10-16.
Resolution 10 G.R. No. 249061
In the 2023 case of Phi/Health v. COA, 61 the Court had outlined case
law settling the issue of the limits of the fiscal independence of PhilHealth. In
the 2016 case of Phi/Health v. COA, 62 and reiterated in 2021 in Phi/Health v.
COA, 63 the Court held that while Republic Act No. 7875 granted PhilHealth
the liberty to fix the compensation of its personnel, it does not necessarily
mean that PhilHealth has an unbridled discretion to issue any and all kinds of
allowances, circumscribed only by the provisions of its charter. 64
The Court thus held that PhilHealth is bound by the provisions of the
Salary Standardization Law; 65 Presidential Decree No. 1597 on the
requirement of Presidential approval for the grant of allowances, honoraria,
and other fringe benefits; 66 Public Sector Labor-Management Council
Resolution No. 4, Series of 2022 issued by the DBM, which requires
qualifications to the grant of CNA incentives by government-owned and
controlled corporations, such as Phi1Health; 67 and other prevailing rules and
regulations issued by the OP and the DBM. 68
b. Job Order -
Thus, the Court has already ruled that the grant by PhilHealth of
allowances and incentives to contractual employees cannot be sanctioned. As
held in Phi/Health v. COA, 70 the grant of transportation allowance and projett
completion incentive to contractual employees is inconsistent with the lawful
distinction between the benefits enjoyed by government employees and job
order contractors. Furthermore, the said grant is contrary to the express
provision in the job order contract that the only compensation due to the
contractor was the daily rate agreed upon. 71
Job order contractors and full-time consultants may render services for
PhilHealth, but they are not considered employees. As non-employees, their
compensation shall be determined based on their respective job order or
consultancy contracts. 72
Here, the COA found that the stipulations in the contracts of the job
order contractors clearly provided that: (a) there is no employer-employee
relationship between them and PhilHealth; (b) the services to be rendered are
not considered as government service; and (c) they are not entitled to th,e
benefits enjoyed by the regular employees. On the other hand, it was
stipulated in the contract of the project-based contractors that they shall not
be entitled to benefits other than their daily wages. 73
70
G.R. No. 258100, September 27, 2022 [Per J. Zalameda, En Banc].
71
Id. at 11. This pinpoint citation refers to the copy of the Decision uploaded to the Supreme Court website.
72
Phi!Health v. Commission on Audit, G.R. No. 222129, February 2, 2021 [Per J. Inting, En Banc].at 8-9
This pinpoint citation refers to the copy of the Decision uploaded to the Supreme Court website.
73
Rollo, p. 44.
Resolution 12 G.R. No. 249061
That a belated request for approval from the OP has been made does
not by itself affect the legality of previous actions which have been disallowed
by COA, much less excuse the error. In fact, this is a solid proof that the
disallowed benefits lacked legal basis. On the other hand, even if the Court
were to suspend its judgment and await the presidential approval sought by
PhilHealth, this authority from the OP would not set aside the unlawful nature
of the disallowed payments to non-employees.
74
G.R. No. 262 I 93, July 11, 2023 [Per J. Gaerlan, En Banc].
Resolution 13 G.R. No. 249061
In the case of bench, PhilHealth merely promises that the post facto
Presidential approval is forthcoming. But as pointed out, even if granted, the
disbursement of the disallowed benefits and incentives in favor of the job
order and project-based contractors will remain legally infirm.
The Court has laid down the rules on return of disallowed amounts in
Madera v. COA, 78 thus:
75 Id. at 21-22. This pinpoint citation refers to the copy of the Decision uploaded to the Supreme Court
website.
76 G.R. No. 246313, February 15, 2022 [Per J. Zalameda, En Banc].
77
Id. at 7. This pinpoint citation refers to the copy of the Decision uploaded to the Supreme Court website.
78 Madera v. Commission on Audit, 882 Phil. 744 (2020) [Per J. Caguioa, En Banc].
Resolution 14 G.R. No. 249061
79
Id. at 817-818.
80 Phi!Health v. Commission on Audit, G.R. No. 258424, January 10, 2023 [Per J. J. Lopez, En Banc] at
21. This pinpoint citation refers to the copy of the Decision uploaded to the Supreme Court website.
81
Irene G. Ancheta, et al. v. Commission on Audit, G.R. No. 236725, February 2, 2021 [Per J. M. Lopez,
En Banc] at 14. This pinpoint citation refers to the copy of the Decision uploaded to the Supreme Court
website. See also Securities and Exchange Commission v. Commission on Audit, G.R. No. 252198, April
27, 2021 [Per J. Lazaro-Javier, En Banc]at 20-2 I. This pinpoint citation refers to the copy of the Decision
uploaded to the Supreme Court website.
Resolution 15 G.R. No. 249061
employees despite its patent illegality and irregularity, negating any claim of
good faith. 82 In Phi/Health v. COA, 83 the Court has held:
Notwithstanding the lack of malice or bad faith, this Court finds that
the approving officers should be held solidarily liable due to gross
negligence. It is well settled that patent disregard of case law and COA
directives, as in this case, is tantamount to gross negligence.
82
Phi/Health v. Commission on Audit et al, G.R. No. 250089, November 9, 2021 [Per J. J. Lopez, En
Banc].
83 Id.
84
Id. at 29-30. This pinpoint citation refers to the copy of the Decision uploaded to the Supreme Court
website.
Resolution 16 G.R. No. 24906'1
Finally, as to the certifying officers, the Court has consistently held that
when certifying officers merely guaranteed the availability of appropriations
and determined the completeness of the supporting documents for such
disbursements, without a showing of any bad faith on their actions, these
certifying officers cannot be held personally liable for the disallowed
benefits.87
85 Irene G. Ancheta, et al v. Commission on Audit, G.R. No. 236725, February 2, 2021 [Per J. M. Lopez,
En Banc].
86
Id. at 18. This pinpoint citation refers to the copy of the Decision uploaded to the Supreme Court website.
87
Phi/Health v. Commission on Audit and Chairperson Michael G. Aguinaldo, G.R. No. 250089,
November 9, 2021 [Per J. J. Lopez, En Banc] at 30-31. This pinpoint citation refers to the copy of the
Decision uploaded to the Supreme Court website.
88
Perez v. Aguinaldo, G.R. 252369, February 7, 2023 [Per J. Inting, En Banc] at 9-10. This pinpoipt
citation refers to the copy of the Decision uploaded to the Supreme Court website, Alejandrina v.
Commission on Audit, 866 Phil. 188, 207-208 (2019) [Per J. Carandang, En Banc].
Resolution 17 G.R. No. 249061
In this case, the certifying officers who strictly certified only to the
availability of funds and that the expenditure is properly supported by
documents, should not be held liable following the guidelines under case law.
SO ORDERED.
'M~H
Associate Justice
WE CONCUR:
IN S. CAGUIOA
Associate Justice
~
SA~LAN
Associate Justice
Resolution 19 G.R. No. 249061
RICARD JROSEmOPEZ
Associate Justice
~~~ ~
------1CNT<ffil? T. ~O, JR. ~
Associate Justice •.
CERTIFICATION