Regular audits conducted on claims made under MOH schemes

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The Straits Times, 30 May 2017

Regular audits conducted on claims made under MOH schemes

We thank Dr Yik Keng Yeong (Restart practice of random audits on clinics; May 20) and Mr Edmund Khoo Kim Hock (Use computer algorithms to find patterns indicating CHAS fraud; May 18) for their suggestions to increase the audit capabilities of the authorities on private general practitioner and dental clinics.

The Ministry of Health (MOH) conducts regular audits on claims made under MOH schemes such as Medisave and the Community Health Assist Scheme (CHAS) to ensure compliance with its rules and guidelines.

Random clinic inspections are also held to ensure compliance with MOH’s guidelines on safety and standards of care.

The majority of Medisave- and CHAS-accredited clinics audited comply with the rules.

When non-compliant claims are detected, MOH works with the clinics to rectify any issues.

Clinics with more severe non-compliance issues, such as irregular or fictitious claims, are flagged for further investigation. Appropriate course of action is taken, depending on the nature of the non-compliance.

Apart from clinic inspections and audits, MOH engages Medisave- and CHAS-accredited clinics regularly via circulars, manuals, talks and on-site training sessions at the clinics, to familiarise them with the guidelines.

These will ensure that Medisave and CHAS are used appropriately to support the needs of patients.

Lee May Lin (Ms)
Director
Communications and Engagement Group
Ministry of Health

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Forum Letter
The Straits Times, 20 May 2017

Restart practice of random audits on clinics

When the use of Medisave for medical claims for chronic diseases was first cleared several years ago, the authorities randomly picked many clinics and carried out audits and checks on them.

Mine was audited three times in a space of two years.

Clinics were also scheduled for inspections by Ministry of Health (MOH) officials to ensure that they complied with best practice methods.

A detailed and stringent checklist on all facets of clinic management, using administrative and clinical parameters, needed to be passed before the MOH was satisfied with the clinic's functionality.

Being sometimes blind to their own deficiencies, doctors welcomed this incisive and thoroughly objective assessment of their practice. Clinics complied and were better off for it.

It must be because of the sheer workload that these audits have stopped. They seem to have ended after the majority of GP clinics applied to be on the Community Health Assist and Pioneer Generation schemes.

Random audits and inspections are preferred to ministry and police investigations (Steps to boost transparency of CHAS bills; May 15).

They correct weaknesses in the clinics and doctors' misapplication of charges that occurred not through cheating or incompetence, but through sheer ignorance and inadvertence.

Rather than put resources into the investigation of fraud and shenanigans, perhaps the authorities should beef up their random audit capabilities.

It is far better to forewarn doctors than to charge them when it is really too late.

Yik Keng Yeong (Dr)

Forum Letter
The Straits Times, 18 May 2017

Use computer algorithms to find patterns indicating CHAS fraud

It is hardly surprising that three general practitioner (GP) clinics are being investigated for making fraudulent claims from the Community Health Assist Scheme (CHAS) (Three clinics under probe over errant Chas claims; May 10).

As there are about 950 GP clinics serving an estimated 1.3 million Singaporeans who are eligible for CHAS subsidies, the likelihood of unscrupulous doctors making false or excessive claims cannot be ignored.

In 2015, 650,000 Singaporeans received CHAS subsidies amounting to $167 million of public funds.

The Ministry of Health (MOH) needs to conduct regular audits on GPs to ensure compliance with CHAS guidelines.

Requiring GPs and dentists to issue itemised bills to patients for CHAS subsidies is also a concrete step towards enhancing greater fee transparency and helping patients better understand the treatments and subsidies they receive.

A comprehensive breakdown of consultation fees, medication and minor procedures will enable the MOH to use a data-collection system, whose algorithms are able to sieve out unusual patterns.

Fraud is worth the risk only when carried out on a large scale. Over time, a certain shape and pattern will emerge.

Such fraud can be a massive drain on taxpayers' money which is meant for patient care.

The MOH needs to stamp out cheating in CHAS claims in order to achieve the quality of efficient healthcare that our country so badly needs.

Edmund Khoo Kim Hock