MOH suspends 2 errant doctors from making claims for 6 months

The Ministry of Health has taken action against six private specialists for overtreating, overclaiming or claiming for procedures that were not done, as “part of MOH’s broader efforts to ensure that healthcare costs and premiums remain affordable for all Singaporeans”.

This is the first time it has done so since the Escalation and Enforcement Framework (EEF), which gives the ministry more teeth to act against errant doctors, was put in place on April 1, 2023.

For their “egregious non-compliances”, two of the doctors and their clinics have been suspended from making claims against MediSave or MediShield Life, including the Integrated Shield Plans (IPs), for six months, starting from Aug 5.

The most severe penalty would be to have MOH revoke a doctor’s ability to make claims.

The other four have to undergo in-person training on prevailing MOH guidelines, for non-compliance.

Whistle-blowing and analytics brought these cases to MOH’s notice.

The two doctors who have been suspended are general surgeon Melissa Teo Ching Ching of Melissa Teo Surgery at Mount Elizabeth Novena Specialist Centre and The Surgical Oncology Clinic at Connexion in Farrer; and ophthalmologist Natasha Lim of Dr Natasha Lim Eye Centre at Royal Square@Novena.

Both of them can continue to practice, as well as submit claims to non-IP insurers, including companies that pay for their employees’ treatments. The MOH spokesman pointed out that for both doctors, IP claims made up a significant portion of their incomes.

The ministry is still reviewing whether to refer them to the Singapore Medical Council (SMC), or even the police, for further action.

It did not name the other four doctors who have to undergo training, since their non-compliances were not egregious.

All the claims from these six doctors were reviewed by expert panels of four to five senior doctors from the public and private sectors.

Dr Teo was found to have “severe non-compliance” when she submitted claims under six codes when they were fully covered under just two codes. The inappropriate claim amount she made was $90,000 for the bill of $170,000 – or more than half the bill.

She had been warned previously for a similar offence, but the incident took place before the EEF was set up.

Dr Lim was found guilty of severe non-compliance for six claims, including for procedures for conditions her patients did not have, and also for providing treatments that were not medically necessary.

Two patients had reflective lens exchange where their natural lens were replaced with artificial ones to provide for better sight. These are not claimable against insurance or MediSave. However, the claims made were for cataract surgery – which is claimable – when neither patients, both in their 40s, had cataract.

A claim was made for another patient for corneal ectasia, a condition the patient did not have. When questioned, Dr Lim said the procedure was to prevent corneal ectasia, a condition where the shape of the cornea changes. The panel of experts said this is not standard care.

The bills for Dr Lim’s three patients amounted to $52,000 – all of which were not claimable.

Dr Lim tried to recover the money from one patient after the MOH review, against MOH instructions. The patient complained to the MOH and that was stopped.

All the wrongful claims from the six doctors have been returned to the insurer, MediSave or patient.

The MOH spokesman said these six cases are “part of a larger and separate review to uncover potential professional misconduct by doctors in their financial practices”. He added that this will not be the last batch of doctors taken to task.

Professor Kenneth Mak, Director-General of Health said: “When doctors make inappropriate claims, we take these very seriously as it causes potential financial and physical harm to the patient. 

“Such acts are also not consistent with the core pillars of medical ethics – beneficence, non-maleficence, and justice. While these errant doctors constitute a very small proportion of the medical profession, their actions can have negative implications on the reputation of the medical profession.”

He added: “Hence, we need to send a strong signal to the medical profession that we expect all our doctors to abide by high standards, not only in clinical care, but also in their character.”

Since October 2023, MOH’s expert panels have looked at 34 outlier claims. Of these, 25 claims from 12 doctors were non-compliant. Some of the claims occurred prior to the setting up of the EEF, and those doctors were given a warning.

The MOH has been expressing concern over the rising cost of premiums for IPs covering treatments in private hospitals. Health Minister Ong Ye Kung saying in July that there is a need to break the health insurance vicious circle, including taking action against the minority of doctors making the most egregious and inappropriate insurance claims.