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Jul 2018

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Singapore: Health ministry probes insurance fraud allegations

Source: Asia Insurance Review | Jul 2018

Singapore Life & Health

Dodgy practices have emerged in the healthcare industry, involving doctors, physiotherapists, insurance agents and third-party administrators (TPAs) splitting money from inflated insurance claims among themselves via a referral and commission system.
 
Responding to queries, the Ministry of Health (MOH) said it has received feedback on such practices, and will be looking into the matter, according to a report in TODAY.
 
According to industry sources, some medical doctors are paid commission fees of 20-30% of the physiotherapy bill if they refer their patients – such as those who require rehabilitation due to injury or illness – to private physiotherapy clinics.
 
Meanwhile, some TPAs approach patients to sign up as clients, let the companies manage their healthcare needs, and sort out their insurance claims and payments. The firms’ agents would then reach out to doctors and private physiotherapy clinics and offer to refer patients to them. The clinics may also upsell packages to the clients, paid for by insurance.
 
A MOH spokesperson said, “Fraudulent behaviour such as unnecessary referrals and false claims for services not rendered raises the overall costs of healthcare in Singapore, and leads to Singaporeans paying more for their healthcare services and insurance plans.”
 
The spokesperson reiterated that the Singapore Medical Council (SMC) has ‘provided guidance’ to doctors on appropriate fee arrangements through its ethical code and ethical guidelines. Among other things, it covers the conduct of doctors in private contractual arrangements between healthcare providers and TPAs.
 
In 2016, the SMC barred doctors from paying fees to TPAs that are calculated as a percentage of fees that these doctors charge their patients. This came amid complaints that some middlemen were charging fees of up to 25% of doctors’ fees for referral of patients. 
 
According to a locum physiotherapist, who works with private clinics, some medical concierge firms would approach patients with comprehensive integrated healthcare insurance plans to sign them on as clients. The firms’ agents would then approach doctors and private physiotherapy clinics, offering to send patients to them.
 
The money claimed from insurers would then be split among the parties. Sometimes, the patients and insurance agents would also be involved in the fee-splitting arrangement. A 
 
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