Friday, 24 June 2016

MOH suspends two dental clinics from CHAS scheme for fraud probe

2 dental clinics under police probe for fraud
By Salma Khalik, Senior Health Correspondent, The Straits Times, 23 Jun 2016

The Ministry of Health (MOH) will suspend two dental clinics from offering subsidised care to middle- and lower-income Singaporeans and the Pioneer Generation because of possible dental fraud.

The two are Phoenix Dental Surgery clinics in Ang Mo Kio and Marine Parade. The suspension begins on July 8 for an indefinite period.

A statement from the MOH yesterday said it had referred the matter to the police for investigation into possible criminal offences.

The Community Health Assist Scheme (CHAS) subsidises pioneers and citizens, whose per capita monthly household income is $1,800 or less, for treatments at private medical and dental clinics.

The doctor or dentist makes a claim for the subsidy on behalf of the patient, and the amount is deducted from the patient's bill.

For dental treatment, subsidies, which are paid by the Government, range from $11 to $266.50.

The MOH said the two clinics had continuously made claims that breached MOH rules and guidelines.

This included making claims for procedures that were not carried out. The ministry said it took a serious view of such errant practices.

Although the clinics will not be able to offer patients the subsidy, they may continue operating.

According to its website, the two clinics were set up by dentists Dr Teo Eu Gene and Dr Cheng Jean-Lynn, and employ four other dentists. None were contactable yesterday.

The clinics can regain their CHAS status once they have rectified the faulty claims and can reassure the MOH that they will comply in future. The results of the police investigation will also be taken into account, said the MOH.

This is the first time a clinic has been suspended from the CHAS scheme. About 1,500 GP and dental clinics are on the scheme which, last year, helped 650,000 Singaporeans.

The Straits Times understands that several other dental clinics are also under investigation for inappropriate claims.

The ministry does regular audits of participating clinics and finds the vast majority "are compliant".

It said non-compliance can sometimes be due to simple administrative errors, such as recording dates wrongly.

More serious are when the claimed procedure does not match the actual treatment, or when claims are made for procedures that were not done. Sometimes, claims are made for treatments that are not eligible for a CHAS subsidy. When these are discovered, the clinics have to make good on the claims they have received.

The MOH added that cases that involve "potential professional misconduct" will be referred to the professional body for disciplinary action. It added: "For cases where criminal misconduct is suspected, the cases will be referred to the police."







* More clinics under probe for possible cheating
MOH has asked the police to look into more questionable subsidy claims under CHAS
By Salma Khalik, Senior Health Correspondent, The Straits Times, 4 Jul 2016

More clinics are under probe for possibly cheating the Ministry of Health (MOH) when claiming subsidies for patients under the Community Health Assist Scheme (CHAS).

Two dental clinics have already been suspended from the scheme. The suspension will start on Friday.

MOH told The Straits Times that it has asked the police to look into more questionable claims, made by an unspecified number of other clinics, under CHAS.

The scheme lets private clinics treat patients who are eligible for a government subsidy, and claim the subsidy from the ministry.

Last week, MOH announced the suspension of the two dental clinics - Phoenix Dental Surgery clinics in Ang Mo Kio and Marine Parade - from CHAS. It had filed a police report against them for possible fraud on April 22.

Under CHAS, MOH has to give a clinic 15 days' notice of termination, so the clinics facing suspension are on CHAS until this Friday.

The ministry told The Straits Times it has "also referred other clinics to the police for further investigation". But it would not say if they are dental or general practice (GP) establishments. About 1,500 clinics are on the CHAS scheme.

The possible cheating cases surfaced via regular audits by MOH and a patient's complaints.

In the case of the two dental clinics, the MOH spokesman said: "While we were auditing the clinics, we also received a patient complaint that Phoenix Dental had submitted claims for procedures which had not been done for the said patient."

Associate Professor Patrick Tseng, Singapore's chief dental officer, said: "MOH takes a serious view of fraudulent claims and unlawful practice behaviour, and we will take necessary action if we suspect any such activity."

The audits have turned up cases of non-compliance, but many are unintentional or administrative errors, such as putting down the wrong date for a procedure. They have also turned up more questionable "errors", such as:

• Doing a simple procedure but making a claim for a more complex, and hence more expensive, treatment.

• Making claims for procedures that are not eligible for subsidy, by classifying it as a different procedure that is subsidised.

• Making a full claim although the treatment has not been completed.

• Claiming for a procedure that was never done.

The MOH spokesman said the ministry will recover any subsidies paid out through incorrect claims. Last year, CHAS paid out $167 million in subsidies to GPs and dental clinics for treating 650,000 Singaporean patients.






Health Ministry must do more to deter fraud
By Salma Khalik, Senior Health Correspondent, The Straits Times, 4 Jul 2016

The news that several clinics are under investigation for possibly cheating the Ministry of Health (MOH) by making false or excessive claims for subsidies to patients, is extremely unsettling.

The MOH has already suspended two dental clinics for a series of "non-compliant" claims, including claiming for procedures that were not done. That was under the Community Health Assist Scheme(CHAS) where the Government pays part of the cost of treatment for middle- and lower-income Singaporeans, and the Pioneer Generation(PG), at private dental and general practice (GP) clinics.

There have also been at least two cases of dentists making excessive claims from patients' Medisave accounts - without their express permission or even knowledge.

These show that even among doctors and dentists, professionals held in high esteem, there are crooks. That undermines the trust patients have in these medical professionals when some among them are willing to cheat to make a fast buck.

But doctors and dentists are not the only ones at fault. MOH also bears some blame.

The CHAS and Medisave schemes have been described by one dentist as the equivalent of "a blank cheque". Speaking on grounds of anonymity, he and several other dentists said they reckon millions of dollars are being siphoned off by unscrupulous colleagues.

One gave the example of a procedure like scaling to remove plaque or prevent tooth decay, where it is left to the dentist to decide whether the work done was simple or complex. If the patient is a PG, the dentist can claim $30.50 for a simple procedure and $53 for a complex one. The dentist said: "For some treatments, I'd rather have a PG patient because the subsidy is more than what I'd charge my patients."

Take the example of a treatment that involves scaling, polishing and applying flouride to prevent decay, for which he would normally charge a patient about $75-$80. Under the PG subsidy, he can claim up to $114.

The MOH has even uncovered claims for procedures that were never done, or where patient case notes were so scanty it is impossible to ascertain the treatment given. The Straits Times understands that there are cases where copies of X-rays in a patient's file do not match the patient's teeth.

These could be due to sloppy practices but that too would be worrisome as poor note-taking and wrong X-rays can lead to wrong or inferior treatment.

In one case involving Medisave claims, the patient complained to the Singapore Dental Council that the dentist had misrepresented to her that the entire cost of a dental implant could be paid for by Medisave.

During the disciplinary inquiry into the case, it emerged that the dentist had made several claims against her Medisave - the $1,250 maximum for an implant and $950 for bone graft and $250 for drainage.

When the patient saw the $2,450 withdrawn from her Medisave, she asked the clinic for a breakdown of the claims, but did not receive any details. An X-ray by another dentist some months later showed that the patient did not have an implant.

The disciplinary committee said: "Misconduct involving the misrepresentation by a dentist, especially one involving using Medisave funds as an enticement, ought to be frowned upon."

In another case, the dentist was not found guilty because of the way the charges against him were framed, but the committee said if the charge had been a breach of professional ethics, it "would have been proved".

The dentist also could not produce a complete set of X-rays, which the committee said "was extremely shoddy".

It published its finding "for the benefit of the public and to raise the standard of the dental profession" without naming the dentist. The dentist had taken $3,700 from the patient's Medisave for various procedures. But the disciplinary committee found that he had not done those procedures. Instead, by making various claims from the complainant's Medisave Account, he sought to raise sufficient monies to pay for the dental implant procedure.

Dentists are apparently doing the same for CHAS claims. These "Robin Hood" dentists believe they are helping poor patients who might otherwise find the treatment in question too expensive. They may have good intentions but making false claims to help patients enjoy bigger subsidies is wrong, and illegal.

In both Medisave cases, the patients noticed and questioned the amount of money withdrawn from their accounts. But that is because Medisave belongs to the individual. Subsidy from CHAS comes from the Government, and while patients sign a consent form, few know the details.

While the MOH says it audits the clinics, such audits must necessarily be infrequent as the ministry's resources are limited. It is also difficult to know if procedures were actually done, without checking with patients. But medical and dental fraud can be a massive drain on public funds that would otherwise have gone to patient care.

Since 2007 the United States has recovered more than US$6 billion (S$8 billion) in fraudulent medical claims.

While the $167 million the MOH paid out in subsidies to GP and dental clinics last year is nowhere near that sum, and is just a small fraction of the ministry's annual expenditure of more than $9 billion, it should nevertheless take steps to prevent such abuse.

With improved technology, data analytics has helped insurers prevent such theft. For example, it can flag when a clinic regularly makes multiple claims for a patient against CHAS or Medisave, which auditors can then follow up on.

Another way is to get patients themselves to help monitor claims. Most patients do not know how much CHAS subsidy the dentist has claimed on their behalf; all they know is that they have to pay very little, or even nothing, for treatment.

But if they receive an itemised statement and see that claims have been made for procedures they did not have, they can alert the MOH to this.

Last year, 650,000 Singaporeans received CHAS subsidy. If just a fraction of them scrutinise these annual statements and alert the authorities when there is a discrepancy, it will make policing the system much easier. Knowing that such a system exists would also give unscrupulous doctors and dentists pause.

It will not completely do away with fraudulent claims, but a foolproof audit would be too onerous. That could discourage people from using CHAS, which would be a pity since it is a good scheme.





* Parliament: CHAS - Itemised bills may be mandatory
MOH considering this following complaints of overcharging at some private clinics
By Salma Khalik, Senior Health Correspondent, The Straits Times, 12 Jul 2016

The 1,600 medical and dental clinics here which offer a government subsidy to patients may soon have to issue itemised bills to them.

This emerged during a parliamentary debate yesterday on overcharging and over-servicing by general practitioners (GPs) and dentists on the Community Health Assist Scheme (CHAS), which provides 1.4 million Singaporeans with subsidised treatments at private clinics.

Minister of State for Health Lam Pin Min said the ministry had received about 300 complaints in the three years from 2013 to 2015, "a relatively small number" given the 5.8 million claims during that period.

About half of the complaints were about charges such as incorrect billing and high fees. There were also complaints about clinics refusing to provide itemised bills.

Ms Lee Bee Wah (Nee Soon GRC) suggested making itemised bills compulsory so patients can check what they have been billed for.

When Dr Lam said the Ministry of Health (MOH) is looking into whether this is necessary, Ms Lee asked: "Why is it so difficult, given so much feedback on overcharging?" Dr Lam then said that the MOH is "seriously considering making it compulsory" and "we will announce this very soon".

Mr Seah Kian Peng (Marine Parade GRC) asked how widespread excessive claims were and if the recent suspension of two dental clinics for possible cheating was just the tip of the iceberg. "These are serious monies that are going out, taxpayers' monies," he said.

Dr Lam said a few more clinics have been referred to the police, but was unable to give details until investigations are completed.

Mr Leon Perera, a Non-Constituency MP, said residents have told him that GPs charge a consultation fee for a follow-up visit if the patient is claiming the CHAS subsidy, but not otherwise. Dr Lam asked for details so that the ministry can investigate to see if "there is any misconduct or malpractice".

Meanwhile, Mr Liang Eng Hwa (Holland-Bukit Timah GRC) suggested having just one CHAS card as people with the orange card are unhappy with the lower subsidy they get, compared with those with the blue card. Alternatively, he suggested giving more people the blue card as the orange card is "so unpopular".

Dr Lam replied that the MOH regularly reviews the amount of subsidy as well as the scope of coverage. It was public feedback that led it to remove the age criterion for the CHAS card in 2014. It used to be only for people aged 40 years and older.

He told Mr Cedric Foo (Pioneer) that half of all Singaporeans qualify for CHAS, with the bottom 30 per cent getting the blue card and the next 20 per cent the orange card.




Related
MOH suspends Phoenix Dental Surgery Clinics from the Community Health Assist Scheme

Parliamentary Q&A - 11 Jul 2016
- Complaints by CHAS cardholders against CHAS clinics
CHAS Control Measures
- Feedback on CHAS

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