Inappropriate Claims by Doctors Involving MediShield Life

NOTICE PAPER NO. 2311
NOTICE OF QUESTION FOR WRITTEN ANSWER
FOR THE SITTING OF PARLIAMENT ON 6 November 2023

Name and Constituency of Member of Parliament
Mr Don Wee
MP for Chua Chu Kang GRC

Question No. 5103

To ask the Minister for Health in each of the last five years (a) how many cases of inappropriate claims have been made by doctors involving MediShield Life; (b) what is the monetary quantum involved; (c) how many cases of valid claims have been wrongfully denied by insurers and what is the quantum involved; and (d) what new measures are in place to ensure that the investigative teams have sufficient resources and authorisation support to conduct enforcement.

Answer

1     Since October 2022, the Claims Management Office (CMO) has adjudicated 32 claims, and another 70 are currently being adjudicated. Out of the 32 claims processed, 29 were assessed by relevant panels of specialists from the public and private sectors to be inappropriate, and which amounted to about $400,000.

2     Where inappropriate claim behaviours are found, MOH will take required enforcement action under the terms and conditions of the MediSave MediShield Life Schemes. For serious cases, providers may also be referred to the Singapore Police Force (SPF) for further investigation, or to the Singapore Medical Council (SMC) for professional or ethical breaches. 

3     MOH and the Monetary Authority of Singapore (MAS) do not track the number and quantum of Integrated Shield Plan (IP) claims that have been denied by insurers. MAS requires insurers to be fair in their treatment of policyholders.  Policyholders who feel that their claims have been wrongfully denied can seek recourse with the Clinical Claims Resolution Process (CCRP) and the Financial Industry Disputes Resolution Centre (FIDReC).