SMC warns doctors to adhere to guidelines on middlemen’s fees
In cases where medical consultations are performed online and MCs issued electronically, doctors must ensure security protocols to prevent fraud. Photo: AFP
SINGAPORE — Doctors will get into trouble if they work with middlemen who charge administrative fees that are based on the services that doctors provide or the fees that they charge patients, the medical watchdog confirmed on Friday (June 23).
In an advisory to doctors, the Singapore Medical Council (SMC) also warned that it will treat any breach of ethical guidelines on fees paid to these middlemen – called third-party administrators (TPAs) – “seriously”. The guidelines take effect on July 1.
The SMC will refer to a complaint panel any complaint or information received, that a doctor has paid a middleman fees in breach of the guidelines. A complaints committee will inquire into the complaint or information, council president Tan Ser Kiat wrote.
Earlier this month, TODAY had reported that doctors were concerned some TPAs’ fee proposals would contravene the new ethical guidelines in spirit, although percentage fees had been scrubbed out of the new fee structures.
Administrative fees are paid to TPAs for services such as IT systems and liaison with insurers and employers that provide medical coverage for their employees. But fees that are too high could jack up costs for patients or compromise the treatment doctors provide.
Percentage fees are not allowed under SMC’s new guidelines for doctors on TPA fees, which state that the fees doctors pay should be based on actual work done by TPAs in processing medical claims.
TODAY also reported that doctors were uncertain how strictly the SMC – a government body that regulates doctors here – would enforce the new rules. Some wondered if they should suspend contracts with some TPAs while they waited to see if any of their peers got into trouble for working with those TPAs.
Prof Tan noted that some new fee structures appear to be tiered and “primarily based” on fees payable to the doctor, amounts claimable by a patient, or the Ministry of Health’s table of surgical procedures (which classifies procedures according to complexity).
Fee structures that appear to be based on services that doctors provide, or fees doctors collect, will not be in compliance with the SMC’s new ethical guidelines, he said. But the SMC is unable to comment on the fee structures of individual TPAs.
Prof Tan reminded doctors that the onus is on them, and not the TPAs, to ensure that fees paid are in compliance with SMC’s guidelines.
Revised fee structures should more adequately explain how the fees reflect work done by the TPAs, he said. Doctors should not enter into agreements with TPAs, if uncertain whether they breach the rules.
Separately, three medical professional bodies also issued an advisory on Friday. Doctors should ask TPAs to justify the fees they charge, “to a standard the doctor is confident will be defensible to the SMC”, said the Academy of Medicine, Singapore, the College of Family Physicians, Singapore and the Singapore Medical Association.
The TPAs’ fee range and fee structures vary. For specialist inpatient fees, for example, MHC Asia Group is charging S$20 to S$180, Alliance Medinet charges from S$25 to S$440; and Parkway Shenton’s iXchange charges from S$100 to S$1,000. Other TPAs include IHP and Fullerton Health.
When contacted on Friday, Alliance Medinet did not respond by press time, while Fullerton Health and Parkway Shenton were confident their fee structures comply with SMC’s guidelines.
“Parkway Shenton agrees that admin fees paid by doctors should reflect the work done by TPAs. We are encouraged by SMC’s most current advisory, where it clarified that tiered fixed fee structures are permissible,” said Mr Adrian Lee, its chief executive-designate.
“We are confident that our tiered fee structure fully reflects the effort done to process, adjudicate and support the administration of claims, and is aligned and compliant with SMC’s guidelines,” he added.
