The moral compass of the elites

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Without international pressure, will the PAP government voluntarily clamp down on arms transfers made through SG?

Singapore will stop arms transfers without blocking legitimate trade with Myanmar: MFA​

Singapore will continue with efforts to prevent the Myanmar junta from accessing military supplies through the Republic. PHOTO: REUTERS
Varun Karthik

Jun 29, 2024

SINGAPORE – Singapore will continue with efforts to prevent the Myanmar junta from accessing military supplies through the Republic while being mindful about not blocking legitimate trade and transactions with Myanmar as that will hurt civilians there, the Ministry of Foreign Affairs (MFA) said on June 28.
“Legitimate trade and financial links between Singapore and Myanmar are necessary to support the livelihoods of the Myanmar people,” MFA said in a statement.
“We have been very careful to avoid inadvertently causing greater hardship for the Myanmar people.”
The statement came in response to media queries following the release of a report by UN Special Rapporteur Tom Andrews on June 26.
The report, which lauded the city-state for its decisive action in clamping down on both the export of military materials from Singapore and the facilitation of arms transactions by banks here, called for financial institutions to “terminate or freeze all financial relationships with Myanmar’s state-owned banks” while “(undertaking) enhanced due diligence on all business relationships and transactions related to Myanmar”.
MFA said: “Singapore’s policy is to prohibit the transfer of arms to Myanmar and to not authorise the transfer to Myanmar of dual-use items, which have been assessed to have potential military application and where there is a serious risk they may be used to inflict violence against unarmed civilians.”
It added: “At the same time, it is not the intention of the Singapore Government to block legitimate trade with Myanmar. Special Rapporteur Andrews’ findings underscore the effectiveness of Singapore’s policy, especially through the measures imposed by Singapore financial institutions (FIs).”

The ministry said FIs based here “will not facilitate any transactions that involve the sale and transfer of arms to Myanmar”, and that banks here have been applying enhanced due diligence on transactions involving Myanmar entities and individuals.
It noted that the Monetary Authority of Singapore had published a circular in August 2023 providing banks with additional guidance on the measures they should incorporate to better detect and manage sanctions-related risks.
“Singapore FIs also had success in the deployment of data analytics to better identify risks and apply appropriate risk-mitigation measures, in particular around the detection of front and shell companies being used to potentially evade sanctions,” MFA said.
“We await specific and actionable information from the Special Rapporteur’s Office so that we are able to conduct the necessary checks on the leads provided in his latest report, and ensure that our FIs and companies are taking the necessary measures to address the risks posed.”

 

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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

Aug 05, 2024

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.

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.

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.

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.

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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 Centre
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”.

2. Dr Natasha Lim Pei Yee​

Natasha Lim Eye Centre at Royal Square@Novena
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.

3. Doctor C​

Gastroenterologist
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”.

4. Doctor D​

Cardiologist
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.”

5. Doctor E​

Orthopaedic surgeon
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.

6. Doctor F​

Ophthalmologist
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.

 

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Socialite Kim Lim announces pregnancy as a single mother​

Kim Lim broke the news with a video on Instagram which showed her celebrating her birthday and having a gender reveal party. PHOTO: KIMLIMHL/INSTAGRAM

Jan Lee
Correspondent

Aug 07, 2024

SINGAPORE – Singaporean socialite and beauty entrepreneur Kim Lim has announced her pregnancy on social media.
She broke the news with a video on Instagram on Aug 7, which showed her celebrating her birthday and having a gender reveal party with a massive fireworks display on a yacht along the Chao Phraya River in Bangkok, Thailand, on Aug 6. She turned 33 in July.
In the video, Lim, dressed in a white cropped T-shirt and grey sweatpants, was seen crying and touching her baby bump while looking up at the sky. She is said to be five months pregnant after going through rounds of in-vitro fertilisation.
Drones formed words in the sky to wish her a happy birthday. They also formed a cartoon-like image of a dragon to signify the current Chinese zodiac year. And they posed the questions: “Is it a girl? Is it a boy?” The video was cut off before the answer was revealed.
Lim, the daughter of Singaporean billionaire tycoon Peter Lim, has a seven-year-old son, Kyden, from her first marriage with Kho Bin Kai. The pair married in 2017 and divorced in 2020.
She married her second husband Leslie Leow in a lavish, star-studded wedding in February 2022, but they split up two months later.
It is not known who the father of her unborn child is or when her due date is. Given the reference to the dragon zodiac sign, it is likely that she is due within the current zodiac year, which ends on Jan 28, 2025.

In a caption accompanying the video, Lim, who said she had been waiting for this moment for a long time, indicated that she embraced her status as a single mother.
She wrote: “My heart especially goes out to all the single mothers out there. I understand the journey can be incredibly tough, especially when there are fewer resources available for you compared with married couples. The struggle is real, and it’s okay to feel overwhelmed.
“But please know, single mummies, we see you, we recognise your strength and we want you to know that you’re not alone on this journey. We are here for you because we truly care. Your resilience and dedication are inspiring, and together, we can support one another through the challenges.”

The gender reveal party, organised by luxury events planner Lelian Chew, included guests such as local influencer JianHao Tan and his wife Debbie Soon.
Soon posted on Instagram a shot of herself with Tan and Lim, and said: “Oh, how you have planned and longed for this, and watching how you’ve gone through so much for this little dragon makes me emotional. I am over the moon for you, big sis. Little baby is already so loved by us all.”

 

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Inflated insurance claims: MOH sends strong signal with action against doctors​

Salma Khalik
Senior Health Correspondent

Two specialists were suspended from making claims against MediSave, MediShield Life and Integrated Shield Plans for six months. PHOTOS: ST FILE

Aug 08, 2024

SINGAPORE - Six doctors have been taken to task for making wrongful insurance claims against unnecessary treatments, excessive claims and procedures that were never carried out, but the crackdown by the Ministry of Health (MOH) is still ongoing and more doctors are likely to feel the heavy hand of the regulators.
Two specialists, for their severe non-compliance, were suspended from making claims against MediSave, MediShield Life and Integrated Shield Plans (IPs) for six months.
The other four private sector specialists have to attend in-person training to refresh their knowledge of what can be claimed from insurance and how claims should be made.
Reactions to the MOH action have been mixed, with some people shocked at such conduct while others sympathised with the doctors, saying that it is easy to make mistakes and what they did was to help patients avoid paying big bills.
Nonetheless, whether or not these were unintentional mistakes, the ministry has indicated it will have little tolerance for wrongful claims that will ultimately lead to higher medical costs for everyone.
Yes, mistakes can happen. But MOH has made clear these erroneous claims are not first offences that draw simply a warning, and may in fact take legal action if such is warranted.
Furthermore, it is incumbent on doctors and clinics to know how to submit claims properly.

Even “honest” mistakes due to lack of knowledge are inexcusable, since the result is to make the patient or insurer pay more than they should. Too many “accidental” excessive claims would result in huge amounts of money wrongfully paid out. The losers are the insurance policyholders, whose premiums will go up.
To give doctors the time to work out the process for making claims, MOH allowed a six-month transition period, where they were not penalised for wrongful claims.
Since that grace period elapsed, MOH has decided that two doctors deserved harsher punishment for their actions – citing “aggravating factors” of repeated non-compliance and recalcitrant behaviour for surgeon Melissa Teo, and ophthalmologist Natasha Lim’s attempt to recover the monies from her patient against the ministry’s instructions.

Dr Teo submitted a claim for one operation under six different codes instead of two as prescribed by the Table of Surgical Procedures (TOSP) codes.
This effectively meant she was making more claims for the same operation than justified.
This was not an unintended mistake. She told The Straits Times that the surgery was complex, involving several organs, and can sometimes take up to 18 hours to complete.
However, the complexity of a procedure is already taken into consideration by the TOSP. The TOSP lists about 2,400 procedures, including those involving multiple organs. The codes also indicate the maximum payout from the basic MediShield Life and MediSave accounts.
MOH said Dr Teo’s claim of $170,000 for the one procedure included $90,000 in “inappropriate claims”.

An orthopaedic surgeon ordered to undergo training had also coded claims wrongly for two patients. He treated them for bunions, submitting claims under four codes each. Two of the codes were for a higher category than the procedures warranted and came with a higher payout than merited. The other two were inappropriately multi-coded when a single code was enough.
In some of the cases, it could be argued that the doctor was helping the patient. Helping a patient game the system could land them both in hot water.
MOH found that Dr Lim had made claims for four cataract operations in patients who either did not have any cataract, or had mild cataract that did not require surgery, among other issues.
The four procedures she actually carried out were to insert refractive lenses into both eyes of both patients to correct their vision. But vision correction, except in very severe cases, is not considered a medically necessary procedure and cannot be claimed against insurance. Cataract surgery, however, can be claimed.
Making a claim for unnecessary procedures is also a no-no. One gastroenterologist performed both gastroscopy and colonoscopy on a patient with gastric symptoms, who needed only the former, which is an examination of the stomach.
It is not unusual for doctors to suggest that patients do both procedures at the same time. Colonoscopy to check for colon cancer is a recommended screening tool. But neither MediShield Life nor IPs pay for screening – only for treatment that is medically indicated.
The doctor’s mistake was to submit claims for both procedures. The correct thing to do would be to submit a claim for the gastroscopy, and bill the patient for the colonoscopy.
Similarly, was the cardiologist who admitted two young patients for a “barrage of tests” instead of carrying out just the appropriate tests in an outpatient setting trying to save his patients’ money?
A panel of senior doctors who reviewed these cases said that not only did the two not need to be admitted given their low level of risk, they also did not need all the tests they were put through.
Then there was the eye doctor whose patient needed only cataract surgery. Instead, on top of that, the ophthalmologist also inserted a capsular tension ring that should have been used only if the patient had other eye problems. In this case, MOH said not only were the claims higher than they should have been, but the patient was also exposed to additional risk.
The vast majority of doctors are conscientious and honest. The six doctors represent less than half a per cent of the more than 2,000 specialists working in the private sector, but their actions do reflect badly on everyone.
Hopefully, by showing it is willing to flex its muscles, MOH has sent a strong warning to doctors to be rigorous with their claims and no more such cases will emerge. It will be a sad day if patients’ trust in the private sector, an integral part of the healthcare system, is eroded by a small minority.