Measures to Prevent Healthcare Insurance Fraud
Ministry of HealthSpeakers
Summary
This question concerns measures to prevent healthcare insurance fraud, as raised by Ms Joan Pereira regarding the Ministry of Health's collaboration with medical professionals. Minister for Health Gan Kim Yong highlighted that the Ministry monitors MediShield Life and Integrated Shield Plan claims for anomalies and refers suspected criminal offenses to the police. Professional standards are upheld through the Singapore Medical Council’s Ethical Code and Ethical Guidelines, which prohibit financial considerations from influencing clinical judgment and mandate disciplinary action for non-compliance. These efforts aim to control healthcare costs by preventing unethical practices like inappropriate referrals, false claims, and business-influenced clinical management. Furthermore, all stakeholders are encouraged to report suspicious propositions or fraudulent behavior to the Ministry, Council, or police to ensure system integrity.
Transcript
10 Ms Joan Pereira asked the Minister for Health how is the Ministry working with doctors and healthcare staff to prevent healthcare insurance fraud.
Mr Gan Kim Yong: MOH takes a serious view of any attempts to defraud the healthcare system at the expense of Singaporeans. Fraudulent behaviour, such as inappropriate patient referrals for financial gains and making false claims for services, is wrong and unethical. It also raises the overall costs of healthcare in Singapore, leading to Singaporeans paying more for their healthcare services and insurance plans.
Various stakeholders have a part to play in combating healthcare insurance fraud. MOH monitors the landscape of MediShield Life and Integrated Shield Plan (IP) claims, and works with IP insurers to identify anomalous trends. For cases where criminal offences are suspected, MOH and insurers will refer them to the police for further investigation.
The Singapore Medical Council (SMC) provides guidance to doctors through the Ethical Code and Ethical Guidelines (ECEG) on ethical practice and professional standards to ensure the wellbeing of patients. In particular, the ECEG prohibits doctors from letting business or financial considerations influence the objectivity of their clinical judgement in their management of patients. Doctors who contravene the ECEG can be subject to disciplinary action by SMC.
Doctors, healthcare staff, patients, insurance providers, financial advisors and members of the public should lodge a complaint to MOH, SMC or the police if they suspect any fraudulent behaviour, or receive any suspicious propositions in relation to their healthcare services or health insurance claims.