The Ministry of Health (MOH) is cracking down on improper MediShield Life claims, with ten doctors being mandated to undergo training after breaching guidelines. This development, announced on 13 November 2024, highlights ongoing efforts to ensure the integrity of Singapore’s healthcare claims system.
Nature of Violations
The doctors involved, who remain unnamed, committed various infractions, including:
- Inappropriate multi-coding — submitting multiple, unnecessary procedure codes.
- Upcoding — assigning codes for more complex procedures than performed.
- Substituting cosmetic procedures as medical claims — a significant concern for MOH.
For instance, one ophthalmologist received reprimand after signing off on an upper droopy eyelid surgery that was found unnecessary upon further review. This incident involved patients undergoing surgery not required to treat a medical condition, raising alarms about the submission practices.
Training and Monitoring
The affected doctors will attend mandatory training focused on proper claiming practices and adherence to clinical guidelines. In addition, their future claims will be closely monitored, with the potential for severe penalties, such as suspension of their MediSave and MediShield Life accreditation, should further non-compliant claims arise.
Improvements in Claims Patterns
Since establishing the Claims Management Office (CMO) in 2022, MOH has adjudicated 130 MediShield Life claims across ten specialties, reinforcing the importance of compliance. Health Minister Ong Ye Kung noted that improper claims have decreased by 55 per cent between 2022 and 2024 due to these interventions.
The Bigger Picture
Despite these improvements, Minister Ong highlighted that improper claims are not the primary factor behind rising private hospital bills. He called for a reassessment of the insurance structure, emphasizing the need for cooperation among regulators, insurers, clinicians, and patients to address the issue comprehensively.
MOH remains resolute in its commitment to tackling inappropriate financial claims, urging healthcare providers to familiarise themselves with guidelines to ensure all treatments are medically appropriate.