Doctor who made inappropriate MediShield Life claims has suspension cut by two months: MOH

Surgical oncologist Melissa Teo, who was suspended for six months from MediShield Life and MediSave accreditation in August, has had her suspension cut by two months. She was suspended for making “severe non-compliance” claims against MediSave or MediShield Life, including Integrated Shield Plans.

The Ministry of Health (MOH) announced the reduced suspension on Oct 28, saying it had considered her belated representations received on Sept 6 and accepted that she could have misunderstood certain guidelines.

It, however, “remains of the view that a suspension of Dr Teo and her two clinics is necessary and appropriate in view of her inappropriate coding practices”.

Dr Teo’s reduced duration of suspension will be implemented after she completes mandatory training to familiarise herself with MOH claim submission requirements and passes a proficiency test.

MOH announced on Aug 5 that it had taken enforcement action against six doctors, including Dr Teo, for making inappropriate MediShield Life claims.

That was the first time it had done so since the Escalation and Enforcement Framework, which gives the ministry more teeth to act against errant doctors, was put in place on April 1, 2023.

MOH took action against Dr Teo over severe non-compliance detected in a MediShield Life claim submitted on July 14, 2023, for a surgical procedure she had done.

The claim involved six Table of Surgical Procedure (TOSP) codes, for procedures that were adequately covered by two codes, resulting in additional payments from insurance and the patient’s MediSave.

MOH said Dr Teo had previously been warned about similar non-compliances found in her claims, and therefore, she and her two clinics had their MediShield Life and MediSave accreditation suspended for six months.

Before the ministry’s suspension announcement, it had notified Dr Teo on July 1 of the intention to suspend her accreditation and that of her clinics, and invited her to submit representations by July 15, but she did not do so.

She was served a second notice on July 29, and while Dr Teo and her clinics acknowledged receipt of the notices, MOH said she did not submit any representations.

It was only two weeks after the suspension took effect that Dr Teo wrote to MOH on Aug 19 for an opportunity to submit belated representations, to which the ministry agreed and received on Sept 6.

Dr Teo provided information on a June meeting between her and MOH representatives regarding the TOSP guidelines. Based on this, the ministry accepted the possibility that she might have misunderstood that it was appropriate to use multiple codes in certain situations, even though it is against the guidelines.

Based on her submissions, MOH said the fees that were directly attributable to Dr Teo’s non-compliance were not included in its Aug 5 press release, which stated $170,000 as the total hospital bill and $90,000 as the inappropriate claims.

MOH on Oct 28 clarified that of the $90,000 claimed for the four inappropriate codes, about $54,000, including goods and services tax (GST), was certified as surgeon fees (comprising Dr Teo’s personal fees and that of her assistant surgeon) and $10,800 (with GST) was for the anaesthetist.

The remainder comprised hospital-related fees.

In her reply to The Straits Times, Dr Teo said she welcomed the decision to reduce her suspension and that she had been and remained “committed to abiding by MOH’s coding guidelines”.

Dr Teo also welcomed MOH’s clarification of the figures in its previous press release on Aug 5. “As explained in my submissions, my total procedure fees for the relevant MediShield Life claim were $50,500 (excluding GST),” she added.

MOH reiterated that it is inappropriate for doctors to submit multiple TOSP codes when there is one that sufficiently describes the procedure performed, and that it takes a serious view against those who make inappropriate or wrongful financial claims.

It said such actions result in higher payouts from MediShield Life, premature depletion of MediSave account balances, and additional charges for patients, all of which contribute to escalating claims and insurance premiums.

MOH will continue to take strict enforcement actions against inappropriate claim behaviour as part of its broader efforts to ensure any increase in healthcare costs is sustainable, and that insurance premiums remain affordable for all Singaporeans.

MOH will also be closely monitoring Dr Teo and her clinics for future claims.

Source: Straits Times © SPH Media Limited. Permission required for reproduction.

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