MOH Intensifies Monitoring of MediShield Life Claims to Curb Inappropriate Practices

SINGAPORE: In a bid to curb inappropriate MediShield Life claims, Singapore’s Ministry of Health (MOH) is ramping up monitoring efforts and warning that repeated non-compliance could lead to doctors’ suspension or loss of accreditation under the MediShield Life and MediSave schemes. MOH made this announcement on October 10 as part of broader measures to manage healthcare costs.

To strengthen oversight, MOH established the Claims Management Office (CMO) in 2022, enhancing regular audits with claims adjudication to scrutinize claims more closely. Since October 2022, the CMO has processed 32 cases, identifying 29 inappropriate claims involving 10 doctors, with common issues like incorrect surgical codes, over-servicing, and non-covered procedures.

To guide healthcare providers, MOH introduced claims rules defining appropriate claims for MediShield Life. Specialty-specific claims rules, developed with input from public and private specialists, help clarify procedures. The first set was introduced for gastrointestinal endoscopy in August 2022, with additional rules for ear, nose, throat, and cardiology specialties introduced in September 2023.

When claims are flagged, an independent panel assesses them for compliance with MOH’s guidelines. If a claim is deemed inappropriate, the institution or doctor is required to rectify the error and refund any inappropriate charges without impacting the patient’s financial responsibility.

MOH has also launched an online resource for doctors on the Health Professionals Portal, helping practitioners better understand claim guidelines. Patients, too, are encouraged to check the MOH website for procedure costs to avoid unnecessary risks or expenses for treatments outside MediShield Life’s coverage.

These initiatives reinforce MOH’s commitment to affordable, necessary healthcare for all Singaporeans, balancing coverage with financial sustainability.