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MOH uncovers 29 inappropriate MediShield Life claims involving 10 doctors
One such case involved inflated claims that amounted to more than S$95,000
SINGAPORE — The Ministry of Health (MOH) has uncovered 29 inappropriate MediShield Life claims involving 10 doctors during its investigation into all 32 cases processed by the Claims Management Office (CMO) since the adjudication of such claims began in October 2022.
In a statement released on Tuesday (10 October), MOH said that among the common errors discovered were the use of wrong surgical codes, over-servicing of patients, and submission of claims not covered by MediShield Life – a basic health insurance plan compulsory for Singapore citizens and permanent residents.
In one case, a doctor was said to have submitted multiple surgical codes to claim more than S$95,000 for performing surgery on a patient with stomach and intestinal cancer. The doctor submitted a claim with 10 codes when only four were warranted, resulting in an inflated bill.
The submission of multiple overlapping codes can result in higher bills for the patient, leading to additional out-of-pocket payments and unnecessary MediSave withdrawals, said MOH. The subsequent higher insurance payouts will also eventually result in higher premiums for all.
Another case involved wrongful claims of more than S$5,600 when a doctor performed cross-linking surgery – a two-step procedure using eye drops and UV light – on a patient presented with blurry vision and long-sightedness. Upon investigation, it was found that the patient had cataracts and should have been treated with cataract surgery instead.
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A third case involved a private sector doctor submitting a claim of more than S$10,000 for the repair of ptosis, also known as ‘droopy eyelids’. Subsequent investigations revealed that the criteria for droopy eyelids affecting visual function were not fulfilled and that the surgery was done for cosmetic reasons, but claimed as therapeutic treatment.
MOH said that it is stepping up its monitoring of inappropriate claims and will not hesitate to act against the small minority of doctors who are found to be repeatedly non-compliant despite warnings. Repeat offenders may have their accreditation status under the MediShield Life and MediSave schemes suspended or revoked.
In addition, such offenders may also be referred, where relevant, to the Commercial Affairs Department under the Singapore Police Force for investigation of potential fraud, or to the Singapore Medical Council (SMC) for breaches of the SMC Ethical Code and Ethical Guidelines.
Establishing the Claims Management Office
The establishment of the CMO in 2022 is part of various MOH efforts to manage healthcare costs, alongside other measures, such as the development and publication of fee benchmarks, the use of evidence-based care practices, and regular surveillance audits.
Those efforts, MOH said, will moderate the escalation of healthcare costs, and help ensure the long-term sustainability of MediShield Life funds to protect Singaporeans against large bills for medically necessary treatments, whilst keeping premiums affordable.
The CMO also develops claims rules to provide clarity on appropriate claims. With the claims rules and adjudication process in place, the small minority of doctors who may be making inappropriate claims will have an opportunity to clarify and rectify their practices, said MOH.
Support for doctors in submitting appropriate claims
MOH has also launched a webpage on the Health Professionals Portal to support doctors in better understanding appropriate claims under MOH’s prevailing guidelines.
The webpage serves as a repository of resources for doctors to reference claims rules and case studies for educational purposes.
"MOH has engaged the Councils of the Singapore Medical Association and the Academy of Medicine, Singapore on the claims management initiatives and will work closely with them on further education and outreach to doctors and patients," said MOH.
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