Debated in Parliament on 6 Nov 2023.
Mr Don Wee asked the Minister for Health in each of the last five years (a) how many cases of inappropriate claims have been made by doctors involving MediShield Life; (b) what is the monetary quantum involved; (c) how many cases of valid claims have been wrongfully denied by insurers and what is the quantum involved; and (d) what new measures are in place to ensure that the investigative teams have sufficient resources and authorisation support to conduct enforcement.
Since October 2022, the Claims Management Office (CMO) has adjudicated 32 claims, and another 70 are currently being adjudicated. Out of the 32 claims processed, 29 were assessed by relevant panels of specialists from the public and private sectors to be inappropriate and which amounted to about $400,000.
Where inappropriate claim behaviours are found, the Ministry of Health (MOH) will take required enforcement action under the terms and conditions of the MediSave MediShield Life Schemes. For serious cases, providers may also be referred to the Singapore Police Force for further investigation or to the Singapore Medical Council for professional or ethical breaches.
MAS requires insurers to be fair in their treatment of policyholders. Policyholders who feel that their claims have been wrongfully denied can seek recourse with the Clinical Claims Resolution Process and the Financial Industry Disputes Resolution Centre.
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