MOH takes 10 doctors to task for non-compliant MediShield Life claims
The Health Ministry said the doctors' claims breached MediShield Life rules and all will undergo mandatory training on proper practices.
A doctor speaking to a patient. (File photo: iStock)
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SINGAPORE: Ten doctors have been ordered by the Ministry of Health (MOH) to undergo mandatory training after they were found to have made non-compliant MediShield Life claims between January and October.
The doctors – who were not named – were found to have submitted claims that breached MOH’s guidelines, including inappropriate multi-coding, upcoding, and submitting cosmetic procedures as medical claims, said the ministry on Thursday (Nov 13).
These claims involved practices such as inappropriate multi-coding, upcoding, inappropriate treatment, and submitting cosmetic procedures as medical claims.
The ministry said the doctors will undergo mandatory training on proper claiming practices and adherence to clinical guidelines.
"These doctors will also be closely monitored for future claims submissions, and may face more severe enforcement actions, including suspension or revocation of their MediSave and MediShield Life accreditation, if they are found to make further non-compliant claims," MOH said in a press release.
The doctors taken to task were from the following specialties: urology, orthopaedic surgery, obstetrics and gynaecology, general surgery, plastic surgery and ophthalmology.
THE NON-COMPLIANT CLAIMS
Several cases involved practitioners passing off cosmetic procedures as medically necessary, MOH said. Examples included the correction of upper droopy eyelids, droopy eyebrow and dermatochalasis for baggy eyes - procedures that are not covered by MediShield Life unless they are medically indicated.
MOH, in consultation with the College of Ophthalmologists, developed guidelines in 2018 to help doctors assess when such procedures are medically appropriate.
In one case, an ophthalmologist signed off on the assessment that there was visual blockage, which indicated the need for upper droopy eyelid surgery.
"However, when the panel reviewed the cases, it found that the certified measurements did not correspond with documentation from clinical photographs," said MOH.
"These patients subsequently underwent surgery with a plastic surgeon who submitted the MediShield Life claims. In other words, a claim for surgery that was not required to treat a medical condition was submitted."
The ministry has since issued a notification letter to the ophthalmologist involved on the need to conduct proper certifications in adherence to the guidelines and has notified the plastic surgeon, who is responsible for ensuring claim compliance, to attend mandatory training.
"MOH reminds all ophthalmologists that inappropriate certifications resulting in non-compliant claims may be assessed for professional breaches and may be further referred to the Singapore Medical Council if warranted," said the ministry.
"At the same time, principal surgeons who perform procedures and submit claims for MediShield Life bear the responsibility to ensure that claims comply with MOH’s requirements and that all supporting documentation meets guidelines before submission."
CLAIMS GOVERNANCE
MOH said that since its Claims Management Office (CMO) was set up in 2022, it has adjudicated 130 MediShield Life claims involving 44 doctors across 10 specialties. Enforcement actions were taken against practitioners who submitted non-compliant claims.
The ministry has also issued four sets of Claims Rules - gastrointestinal endoscopy; ear, nose and throat; cardiology and urology - to guide healthcare professionals on appropriate claiming practices.
These efforts have led to improvements in claims patterns, particularly in the private sector. The number of claims with inappropriately paired surgical codes decreased by 55 per cent from 2022 to 2024, MOH said.
Health Minister Ong Ye Kung noted this improvement in a Facebook post on Thursday, adding: "Our interventions have worked."
He said that while improper claims contribute to rising private hospital bills, they are "not the key factor".
The broader issue, he said, lies in the insurance structure, which requires coordination among regulators, insurers, clinicians and patients "to moderate the rapid increase in hospital bills and private insurance premiums".
MOH said it takes a serious view of healthcare providers who make inappropriate or wrongful financial claims and will continue to take strong action against non-compliant practices.
It also reminded healthcare professionals to ensure all treatments, services and procedures are clinically appropriate and to familiarise themselves with prevailing MOH guidelines and circulars.
