Facilitating Legitimate Insurance Claims for Health Procedures and Treatments Despite Recent Wrongful Claim Cases
Ministry of HealthSpeakers
Summary
This question concerns safeguarding legitimate insurance claims following enforcement actions for wrongful claims and the expansion of outpatient claimability to prevent unnecessary hospitalisations. Mr Darryl David inquired about patient protection and shifting procedures to outpatient settings. Minister for Health Ong Ye Kung highlighted a robust enforcement framework implemented in April 2023, where post-claim adjudication ensures policyholders are unaffected while errant providers are required to rectify claims. He noted that MediSave and MediShield Life already cover various outpatient treatments, such as cancer scans, and emphasised that admissions should never be made solely for insurance purposes. Minister for Health Ong Ye Kung added that the Ministry of Health continues to review financing schemes to balance patient needs with long-term cost sustainability.
Transcript
82 Mr Darryl David asked the Minister for Health regarding the recent action taken against doctors for making wrongful insurance claims (a) what steps are taken to ensure that patients who need to claim on their insurance policies for health procedures and treatments are not adversely affected; and (b) whether the Ministry will consider working with relevant parties to allow certain procedures and treatments to be claimable in an outpatient setting, rather than requiring them to fall under the inpatient category to prevent doctors from warding patients unnecessarily to claim from their insurance.
Mr Ong Ye Kung: The Ministry of Health (MOH) takes a serious view against providers who make wrongful financial claims. This is unfair to patients, a waste of public resources and goes against the professional ethics of a healthcare provider.
As of 1 April 2023, MOH has, therefore, instituted a more robust enforcement framework for such wrongful claims. Wrongful claims are surfaced via whistleblowing, complaints channels or analytics. Hence, the claims adjudication process takes place post-claim and the claims process for policyholders is unaffected. After an errant claim is discovered, MOH takes steps to require the healthcare provider to rectify the wrongful claims without affecting the patients.
All treatments and procedures must be administered in the appropriate setting. MOH encourages doctors to perform treatments and procedures in an outpatient or day surgery setting, if it is safe and delivers similar clinical outcomes to inpatient admissions. At no time should they admit patients for the sole purpose of making insurance claims.
MOH has allowed MediSave and MediShield Life claims to be made for selected outpatient treatments and tests, such as scans and blood tests ordered for a patient as part of cancer treatments, or for the purposes of diagnosis and treatment of a medical condition. MOH will continue to review existing healthcare financing schemes to ensure that they address Singaporeans’ needs while ensuring the long-term sustainability of healthcare costs.