PUBLISHED ONNovember 13, 2025 8:48 AMBYKoh Xing YingThe Ministry of Health (MOH) has taken enforcement actions against 10 doctors between January and October 2025 for making non-compliant MediShield Life claims.
In a statement on Thursday (Nov 13), MOH said that these claims involved several improper practices.
These included inappropriate multi-coding — submitting multiple unnecessary procedure codes — and upcoding, where a code is assigned for a more complex procedure than what was actually performed.
MOH added that some cases also involved inappropriate treatments and the submission of cosmetic procedures as medical claims.
Under the Escalation and Enforcement Framework, the ministry said that these doctors will be required to undergo mandatory training on proper claiming practices and adherence to clinical guidelines.
"They will also be closely monitored for future claims submissions, and may face more severe enforcement actions, including suspension or revocation of their MediSave and MediShield Life accreditation, if they are found to make further non-compliant claims," said MOH.
The ministry noted that several claims adjudicated during this period involved practitioners passing off cosmetic procedures as medically necessary.
In one such case, MOH cited an ophthalmologist who had signed off on assessments indicating visual blockage, which suggested the need for upper droopy eyelid surgery.
However, upon review, MOH found that the certified measurements did not correspond with the documentation in the clinical photographs.
"These patients subsequently underwent surgery with a plastic surgeon who submitted the MediShield Life claims. In other words, claims were submitted for surgery that was not required to treat a medical condition," said MOH.
"Treatments that are not medically indicated are not eligible for MediShield Life coverage."
According to the cases listed, the doctors involved — who were not named — spanned specialisations such as urology, orthopaedic surgery, obstetrics and gynaecology, general surgery, plastic surgery, and ophthalmology.
The ministry noted that these enforcement actions were discovered through the the claims adjudication processes of the MOH Claims Management Office (CMO).
"Since its establishment in 2022, the CMO has adjudicated 130 MediShield Life claims involving 44 doctors across 10 specialties, taking enforcement action against practitioners who submitted non-compliant claims," said MOH.
"In addition, the CMO has issued four sets of claims rules to provide clearer guidance to healthcare professionals on appropriate claims under MediShield Life."
The ministry shared that these measures have also contributed to improvements in claims patterns, particularly in the private sector.
Health Minister Ong Ye Kung said in a Facebook post on Nov 13 that, as a result of the CMO's efforts, improper claims have dropped by 55 per cent from 2022 to 2024, proving that the interventions have been effective.
Ong noted that while improper claims are one factor contributing to rising hospital bills in the private sector, they are not the main cause.
"It is, however, not the key factor. We will need to tackle the insurance structure," said Ong, adding that it will require the coordination and understanding of regulators, the insurance industry, clinicians, and patients.
"It is a correction we need to make to moderate the rapid increase in hospital bills and private insurance premiums."
MOH said it takes a serious view against healthcare providers who make inappropriate or wrongful financial claims and will continue to take strong action against non-compliant practices.
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xingying.koh@asiaone.com
