KUALA LUMPUR, Nov 29 — The Ministry of Health (MOH) has mandated managed care organisations (MCOs) or third-party administrators (TPAs) to submit information for a new national MCO/TPA registry.
In a November 25 circular, Health director-general Dr Mahathar Abd Wahab ordered all MCOs (also known as TPAs) dealing with private health care facilities in Malaysia to provide the ministry with the following information:
- Organisational details: company or organisation’s full name, company registration number, registered address, phone number, official email address, and website (if available)
- Details on the officer in charge: name, position, identity card number, phone number, and email address
- Copies of related documents: Form 9 (certificate of incorporation), Form 24 (particular of shareholders), Form 44 (particular of registered address), and Form 49 (particular of directors/officers) under the Companies Act 2016
- Contracts between the managed care organisation and the private health care facility or service
- Other information as required by the Health DG from time to time
“To improve transparency and simplify communications and operational measures, the Health Ministry is taking this step to gather centralised information about entities that carry out the functions of an MCO or TPA in the private health care sector,” said Dr Mahathar in his circular, as sighted by CodeBlue.
The Health DG’s directive was based on Section 85(1) of the Private Healthcare Facilities and Services Act 1998 (Act 586) that empowers the DG to compel the submission of information from MCOs that have contracts with the licence holder of a private health care facility or service.
The information will be entered into an MCO registry, as set in Section 86 of Act 586.
“Details of managed care organisations will be entered into an MCO registry after all information is received. Each managed care organisation will be given an MCO registration number as confirmation,” said Dr Mahathar.
Last night, the MOH issued a press statement on the matter, saying: “Compliance with this directive is crucial to ensure that the country’s private health care system continues operating in a transparent manner for the public interest.”
In a recent interview with CodeBlue, PMCare Sdn Bhd, the country’s oldest TPA at three decades, called for the enactment of a new Act to regulate TPAs and MCOs, adding that it preferred to be regulated by the MOH since managed care entities dealt with medical issues.
The DG’s directive applies to all MCOs, as defined in Section 82 of Act 586, as well as any entities that perform the functions of an MCO or TPA for a payer or benefit provider that fulfils that definition, even if they operate as part of a corporate entity or other bigger entities.
All MCOs are required to furnish the MOH complete information by January 31, 2026. Non-compliance is considered a criminal offence under Section 85(2) and Section 85(3) of Act 586 that is punishable with a fine of between RM100,000 and RM300,000, or imprisonment not exceeding two years, or both.
According to the Google Form provided by the MOH to MCOs/TPAs for information submission, “information collected will be used to develop and maintain a national database on MCO and TPA arrangements in Malaysia”.
Among the information requested is one sample certified true copy of a contractual agreement between the MCO/TPA and a private health care facility; as well as the number of private hospitals, private clinics, and corporate clients (if any) that the MCO/TPA is engaged with.
In a November 28 circular, as sighted by CodeBlue, MOH medical practice division director Dr Hirman Ismail told insurers and takaful operators (ITOs) to extend the Health DG’s directive to all their appointed TPAs.
Dr Hirman’s letter was sent to 55 ITOs and copied to the Life Insurance Association Malaysia, General Insurance Association of Malaysia, Malaysia Takaful Association, Association of Private Hospitals of Malaysia, and Malaysian Medical Association.
On the MOH’s medical practice division’s website, a list of registered MCOs shows 63 companies, with their names, address, phone number, and date of registration with the MOH. The most recent registration was in 2024. There are no MCO registration numbers.
The MOH’s move to create a national MCO/TPA registry followed earlier measures to curb perceived clinical interference by ITOs or TPAs in health insurance.
Last October 31, the MOH’s medical practice division told ITOs and MCOs/TPAs to halt their practice of using previous MOH letters as a blanket rule to justify denials of health insurance claims, saying its medical opinions were limited and specific to the individual case referred.
TPAs such as PMCare have a mix of insurance clients managing group policies for companies and corporate clients that self-pay for employee benefit schemes.
