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The two doctors are from Melissa Teo Surgery at Mount Elizabeth Novena Specialist Centre and Dr Natasha Lim Eye Centre at Royal Square@Novena. ST PHOTOS: GAVIN FOO
Salma Khalik and Judith Tan
Updated
Aug 05, 2024, 11:12 PM
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SINGAPORE - The Ministry of Health (MOH) 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 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 were suspended are general surgeon Melissa Teo Ching Ching from Melissa Teo Surgery at Mount Elizabeth Novena Specialist Centre and The Surgical Oncology Clinic at Connexion in Farrer Park, and ophthalmologist Natasha Lim from Dr Natasha Lim Eye Centre at Royal Square@Novena.
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Both of them can continue to practise, 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.
All the claims from these six doctors were reviewed by expert panels of four or 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 underwent refractive lens exchanges where their natural lenses 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 the patients, both in their 40s, either had no cataract or had mild cataract that did not require surgery.
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Doctors suspended over inappropriate claims explain their actions
MOH revokes suspended GP’s licence to provide outpatient medical services
Claims were made for two patients for corneal ectasia, a condition the patients 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 four 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 the ministry’s instructions. The patient complained to MOH and that was stopped.
All wrongful claims from the six doctors are in the process of being returned to the insurer, MediSave or the 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 at MOH, 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.
MOH has expressed concern over the rising cost of premiums for IPs covering treatments at private hospitals.
Health Minister Ong Ye Kung said 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.
Currently, surveillance of the various MOH schemes to ensure they are carried out appropriately is done by different offices, with different enforcement frameworks.
More On This Topic
Doctor who allegedly gave fake Covid-19 jabs asks for restrictions instead of suspension
Doctor accused of delaying urgent treatments of at least 3 patients through needless tests
There is the Claims Management Office’s Claims Adjudication for surgical and medical claims.
The MOH Holdings’ Group Internal Audit (GIA) covers MediShield Life, MediSave, the Community Health Assist Scheme (Chas) and Healthier SG subsidies.
To align the penalties and enforcement approach across all schemes, MOH said it will progressively implement the same EEF for all cases of non-compliance.
It will start with selected MediSave and MediShield surgical claims audited by GIA from Oct 1, and move on to claims made under the Chronic Disease Management Programme, Chas and other schemes from 2025.
MOH said that in addition to EEF sanctions, it may also refer relevant cases to the Commercial Affairs Department under the Singapore Police Force for investigation of potential fraud/cheating offences, or the Singapore Dental Council and the SMC for disciplinary proceedings in respect of potential breaches of their respective ethical codes and ethical guidelines.
She has been suspended from making claims against MediSave, MediShield Life or IPs for six months, starting from Aug 5.
She submitted claims using six Table of Surgical Procedures codes, when two codes were enough to cover the procedure she had done.
The table is a list of about 2,400 procedures for which claims can be made.
The total bill for the patient was $170,000, of which 52 per cent, or about $90,000, was for “inappropriate items”.
This was not her first offence.
She was warned in June 2023 for another non-compliant claim.
MOH said aggravating factors in her case were “repeated non-compliance and recalcitrant behaviour”.
She has been suspended from making claims against MediSave, MediShield Life or IPs for six months, starting from Aug 5.
She submitted claims for four cases – two patients treated for both eyes – for cataract surgery.
Reviewing the cases, a panel of experts from the public and private sectors found that the claims were inappropriate as these patients either had no cataract or mild cataract that did not require surgery.
She also claimed for two surgical treatments for corneal ectasia for two patients who did not suffer from that condition.
She told the panel that the treatment was to prevent the condition. The panel said that is not standard care.
An aggravating factor in her case was acting against MOH instructions in trying to recover money from a patient for a claim she was asked to rectify.
He submitted claims for gastroscopy and colonoscopy when only gastroscopy was appropriate, given the patient’s symptoms.
MOH said that in doing both procedures, he “exposed the patient to unnecessary risk of physical harm”.
The doctor hospitalised two patients for one night, when it was not necessary to do so. They were put through a barrage of tests.
The expert panel assessed the two patients, who were in their 30s, to be at low risk of cardiac conditions.
All the investigations could also be done in an outpatient setting.
MOH said: “The unnecessary admission caused inappropriate claims from MediShield Life and the patients’ MediSave monies.”
The surgeon submitted claims for treating bunions for two patients.
The claims included two under a higher code (which would involve a more complex procedure), and two with multiple codes when a single code was enough. This resulted in inappropriate claims.
The doctor submitted a claim for cataract surgery with a capsular tension ring.
The patient did not need the capsular tension ring, which is for patients who also have other eye problems.
MOH said the doctor exposed the patient “to unnecessary additional risk of physical harm” as well as made inappropriate claims.
Correction note: This story has been edited for clarity.
More On This Topic
MOH takes 6 clinics to task over non-compliant claims for Chas, Covid-19 schemes
MOH acts against inflated, inappropriate MediShield Life claims; one case involved over $95,000
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MOH suspends 2 doctors from making insurance, MediSave claims for 6 months
The two doctors are from Melissa Teo Surgery at Mount Elizabeth Novena Specialist Centre and Dr Natasha Lim Eye Centre at Royal Square@Novena. ST PHOTOS: GAVIN FOO
Salma Khalik and Judith Tan
Updated
Aug 05, 2024, 11:12 PM
FacebookTelegram
SINGAPORE - The Ministry of Health (MOH) 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 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 were suspended are general surgeon Melissa Teo Ching Ching from Melissa Teo Surgery at Mount Elizabeth Novena Specialist Centre and The Surgical Oncology Clinic at Connexion in Farrer Park, and ophthalmologist Natasha Lim from Dr Natasha Lim Eye Centre at Royal Square@Novena.
Catch up on the news that everyone’s talking about
Sign up
By signing up, I accept SPH Media's Terms & Conditions and Privacy Policy as amended from time to time.
Yes, I would also like to receive SPH Media Group's
SPH Media Limited, its related corporations and affiliates as well as their agents and authorised service providers.
marketing and promotions.
Both of them can continue to practise, 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.
All the claims from these six doctors were reviewed by expert panels of four or 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 underwent refractive lens exchanges where their natural lenses 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 the patients, both in their 40s, either had no cataract or had mild cataract that did not require surgery.
Doctors suspended over inappropriate claims explain their actions
MOH revokes suspended GP’s licence to provide outpatient medical services
Claims were made for two patients for corneal ectasia, a condition the patients 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 four 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 the ministry’s instructions. The patient complained to MOH and that was stopped.
All wrongful claims from the six doctors are in the process of being returned to the insurer, MediSave or the 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 at MOH, 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.
MOH has expressed concern over the rising cost of premiums for IPs covering treatments at private hospitals.
Health Minister Ong Ye Kung said 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.
Currently, surveillance of the various MOH schemes to ensure they are carried out appropriately is done by different offices, with different enforcement frameworks.
Doctor who allegedly gave fake Covid-19 jabs asks for restrictions instead of suspension
Doctor accused of delaying urgent treatments of at least 3 patients through needless tests
There is the Claims Management Office’s Claims Adjudication for surgical and medical claims.
The MOH Holdings’ Group Internal Audit (GIA) covers MediShield Life, MediSave, the Community Health Assist Scheme (Chas) and Healthier SG subsidies.
To align the penalties and enforcement approach across all schemes, MOH said it will progressively implement the same EEF for all cases of non-compliance.
It will start with selected MediSave and MediShield surgical claims audited by GIA from Oct 1, and move on to claims made under the Chronic Disease Management Programme, Chas and other schemes from 2025.
MOH said that in addition to EEF sanctions, it may also refer relevant cases to the Commercial Affairs Department under the Singapore Police Force for investigation of potential fraud/cheating offences, or the Singapore Dental Council and the SMC for disciplinary proceedings in respect of potential breaches of their respective ethical codes and ethical guidelines.
Why action was taken by MOH against 6 doctors over claims
1. Dr Melissa Teo Ching Ching
The Surgical Oncology Clinic at Connexion in Farrer Park and Melissa Teo Surgery at Mount Elizabeth Novena Specialist CentreShe has been suspended from making claims against MediSave, MediShield Life or IPs for six months, starting from Aug 5.
She submitted claims using six Table of Surgical Procedures codes, when two codes were enough to cover the procedure she had done.
The table is a list of about 2,400 procedures for which claims can be made.
The total bill for the patient was $170,000, of which 52 per cent, or about $90,000, was for “inappropriate items”.
This was not her first offence.
She was warned in June 2023 for another non-compliant claim.
MOH said aggravating factors in her case were “repeated non-compliance and recalcitrant behaviour”.
2. Dr Natasha Lim Pei Yee
Natasha Lim Eye Centre at Royal Square@NovenaShe has been suspended from making claims against MediSave, MediShield Life or IPs for six months, starting from Aug 5.
She submitted claims for four cases – two patients treated for both eyes – for cataract surgery.
Reviewing the cases, a panel of experts from the public and private sectors found that the claims were inappropriate as these patients either had no cataract or mild cataract that did not require surgery.
She also claimed for two surgical treatments for corneal ectasia for two patients who did not suffer from that condition.
She told the panel that the treatment was to prevent the condition. The panel said that is not standard care.
An aggravating factor in her case was acting against MOH instructions in trying to recover money from a patient for a claim she was asked to rectify.
3. Doctor C
GastroenterologistHe submitted claims for gastroscopy and colonoscopy when only gastroscopy was appropriate, given the patient’s symptoms.
MOH said that in doing both procedures, he “exposed the patient to unnecessary risk of physical harm”.
4. Doctor D
CardiologistThe doctor hospitalised two patients for one night, when it was not necessary to do so. They were put through a barrage of tests.
The expert panel assessed the two patients, who were in their 30s, to be at low risk of cardiac conditions.
All the investigations could also be done in an outpatient setting.
MOH said: “The unnecessary admission caused inappropriate claims from MediShield Life and the patients’ MediSave monies.”
5. Doctor E
Orthopaedic surgeonThe surgeon submitted claims for treating bunions for two patients.
The claims included two under a higher code (which would involve a more complex procedure), and two with multiple codes when a single code was enough. This resulted in inappropriate claims.
6. Doctor F
OphthalmologistThe doctor submitted a claim for cataract surgery with a capsular tension ring.
The patient did not need the capsular tension ring, which is for patients who also have other eye problems.
MOH said the doctor exposed the patient “to unnecessary additional risk of physical harm” as well as made inappropriate claims.
Correction note: This story has been edited for clarity.
MOH takes 6 clinics to task over non-compliant claims for Chas, Covid-19 schemes
MOH acts against inflated, inappropriate MediShield Life claims; one case involved over $95,000
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MCI (P) 066/10/2023. Published by SPH Media Limited, Co. Regn. No. 202120748H. Copyright © 2024 SPH Media Limited. All rights reserved.
