Enforcement Actions Taken Against Six Doctors for Non-compliant Medishield Life Claims

The Ministry of Health (MOH) has taken enforcement actions against six doctors for making inappropriate MediShield Life claims. Two of the doctors have had their MediSave and MediShield Life accreditation suspended for a period of six months due to severe non-compliances, while the remaining four will be required to undergo mandatory training. The enforcement actions follow the setting up of the Claims Management Office in 2022, and the commencement of the Escalation and Enforcement Framework from 1 April 2023.

2. Under the Framework, there are various enforcement actions that doctors and dentists could be subject to. These range from engagement through a Letter of Advice for less serious cases, to mandatory training, suspension, and ultimately revocation for the most egregious cases.

Six-month suspension of two doctors' accreditation for MediSave and MediShield Life

3. The two doctors who have had their MediSave and MediShield Life accreditation suspended for a period of six months are:

a) Dr Teo Ching Ching Melissa, a general surgeon who is the sole director and sole shareholder of The Surgical Oncology Clinic, located at 1 Farrer Park Station Road, Farrer Park Medical Centre Connexion #09-07, as well as Melissa Teo Surgery, located at 38 Irrawaddy Road, Mount Elizabeth Novena Specialist Centre #08-40. Dr Teo and her clinics' MediSave and MediShield Life accreditations were suspended on 5 August 2024.

b) Dr Lim Pei Yee Natasha, an ophthalmologist who is the sole director and sole shareholder of Natasha Lim Eye Centre, located at 101 Irrawaddy Road, Royal Square @ Novena #19-01/02/03/07. Dr Lim and her clinic's MediSave and MediShield Life accreditations were suspended on 5 August 2024.

4. A severe non-compliance was found through adjudication by a panel of specialists appointed by MOH and the MediShield Life Council in respect of a MediShield Life claim submitted by Dr Melissa Teo. This involved the inflation of her total claim by submitting six Table of Surgical Procedure (TOSP) codes, for procedures that are adequately covered by two codes. This meant that the amount claimed for four codes were inappropriate. Dr Teo had previously been warned by MOH about similar non-compliances found in claims adjudicated before 1 April 2023.

5. Severe non-compliances were found in six MediShield Life claims submitted by Dr Natasha Lim. These include claiming for procedures for conditions that her patients did not have, and providing treatments that were not medically necessary for the patients' conditions. Dr Lim also attempted to recover the inappropriately claimed amounts from one of her patients, despite MOH's instruction not to do so.

6. Both doctors will have their MediSave and MediShield Life accreditation suspended for a period of six months from 5 August 2024, and will be required to undergo mandatory training before the suspension can be lifted. Dr Teo, Dr Lim and their clinics will also be closely monitored for future claims, and may have their accreditation revoked in future, if repeated non-compliances are found.

7. Both doctors have been instructed to inform their patients prior to providing treatment that treatments performed by them on or after 5 August 2024 and until their suspension has been lifted will not be eligible for claims under the MediSave and MediShield Life schemes, and to make any alternative arrangements for them as required.

Enforcement action taken for four other doctors

8. Four other doctors were found to have non-compliant claims that include overservicing, multi-coding and unnecessary inpatient admissions. These doctors will be required to undergo mandatory training to familiarise themselves with prevailing MOH guidelines. They will be closely monitored for future claims and may have their MediSave and MediShield Life accreditation suspended or revoked if repeated non-compliances are found. Please refer to Annex A for details of these cases.

Aligning enforcement approaches across all financing schemes

9. To align the various enforcement approaches across national financing schemes, MOH will progressively implement the same Escalation and Enforcement Framework for non-compliances detected, starting with MediSave and MediShield Life claims that are audited by MOH Holdings' Group Internal Audit from 1 October 2024, and extending to claims made under the Chronic Disease Management Programme, Community Health Assist Scheme and other schemes from 2025.

10. More information on the implementation details will be shared with the medical and dental community in due course.

MOH will continue to take actions against inappropriate claim behaviour

11. These six cases are also part of a larger and separate review to uncover potential professional misconduct by doctors in their financial practices. MOH takes a serious view against providers who make inappropriate or wrongful financial claims and will not hesitate to take strong action against the small minority of doctors who are found to be non-compliant, including referrals to the Singapore Medical Council for disciplinary action. This is part of MOH's broader efforts to ensure that healthcare costs and premiums remain affordable for all Singaporeans.

MINISTRY OF HEALTH

5 AUGUST 2024