‘Exploited’ GPs Told to Sue Managed Care Organisations

Some MCOs pay GPs as low as RM10 per patient for their first visit.

KUALA LUMPUR, May 28 – General practitioners (GPs) should take legal action if they are underpaid by managed care organisations (MCOs), a doctors’ association said.

The Federation of Private Medical Practitioners Associations Malaysia (FPMPAM) alleged that MCOs – which are health care providers that offer managed health care plans by contracting with insurers or employers – made “enormous” profits at the expense of doctors and patients by using the current 27-year-old GP fee schedule of RM10 to RM35.

FPMPAM maintained that private GPs’ consultation fees should follow the 2013 amendment of the Private Health Care Facilities and Services Act 2006 (RM35 to RM125 rate), as GPs operating shop lot practices should not carry the burden of the Health Ministry’s failure to gazette this rate for them like what was done for their hospital-based counterparts.

“We are of the view that any contract with doctors’ professional fees below what is stipulated in law should be null and void,” FPMPAM president Dr Steven KW Chow said in a statement.

“Since 2014, GPs have been underpaid by MCOs, some for as low as RM10 per patient for their first visit,” he added. “The Federation urges all GPs affected to singularly or collectively pursue legal action to reclaim what should be rightly due to them.”

A total of 35 MCOs have been registered with the Health Ministry as of October 2018, including MiCare Sdn Bhd, Health Connect Sdn Bhd, PMCare Sdn Bhd, ASIA Assistance Network Sdn Bhd, AIA Health Services Sdn Bhd, and Compumed Services Sdn Bhd among others.

Dr Chow said many doctors have complained about MCOs not paying their bills for over a year, stressing that payment terms should be 30 days from the date of invoice and interest must be charged for late payment.

“Furthermore, there should be no contracted discount on doctors’ professional fees as this is tantamount to fee splitting.”

FPMPAM also called for a nationwide boycott of MCOs that shortchange doctors and patients, proposing that trade action against MCOs be a resolution taken at GPs’ upcoming town hall meeting with Health Minister Dzulkefly Ahmad if this issue is not resolved.

FPMPAM complained that MCOs have unilaterally imposed many quasi regulations that interfered with doctors’ medical management of patients.

“It is not the right of MCOs and their likes to inspect and audit doctors’ patient or clinic records. It is an infringement of the doctors’ duty to protect the confidentiality of the patient as prescribed by the PHFSA [Private Health Care Facilities and Services (Private Hospitals and Other Private Health Care Facilities) (Amendment) Order 2013] and the MMC (Malaysian Medical Council) Code of Professional Conduct.

“Instead, MCOs and their likes should only be allowed to request for specific information based on specific consent of the patient. Signing of blanket consent forms by the patient should not be allowed,” said Dr Chow.

The Malaysian Insight reported that some MCOs paid clinics in stages instead of settling their bills in full, while a clinic could be suspended from an MCO’s list of panel clinics if it prescribed medicines outside a predetermined list. Clinics are reportedly charged between RM2,500 and RM5,000 to be added onto a list of panel clinics.

Dzulkefly announced a town hall meeting with GPs on June 11, after an uproar when the Cabinet declined to harmonise shop lot GPs’ consultation fees with their counterparts from private hospitals pending a review by a government council on cost of living.

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