third party administrators (TPAs) Archives

7 July 2026

Letter

Balancing Financing And Patient Care: Accelerate Regulating TPAs And MCOs — Dr James Jeremiah

As Malaysia aims to cement its status as a regional health care hub, robust governance is vital to offering regulatory certainty to investors, transparency to patients, and fairness to health care providers.

2 July 2026

Malaysia

Interfering With Medical Practice May Be Illegal, MOH Warns TPAs

MOH warns MCOs and TPAs that undermining doctors' autonomy in treating patients may breach Act 586, stressing that the main role of payers is to facilitate financial and insurance claims administration, not to regulate the practice of medicine.

25 June 2026

Opinion

PAC Report Confirms Need For Urgent Regulatory Reforms In Private Health Care

The Galen Centre strongly supports the PAC’s recommendation for a new and independent governance mechanism for private health care. The government should establish a statutory Private Healthcare Commission with an explicit consumer protection mandate.

26 May 2026

Malaysia

Health Ministry Threatens Enforcement Action Against Doctor Fee-Splitting

MOH pledges action under Act 586 against doctor fee-splitting based on proper investigation and legal assessment. As for TPAs and insurers involved in fee-splitting under discount or panel arrangements, MOH says it may engage the relevant authorities.

9 January 2026

Malaysia

PMCare To Honour Claims By Panel Doctors Without Valid APC

PMCare says it will honour claims for services rendered by existing panel doctors awaiting 2026 APC, but medical practitioners who want to join the TPA's panel must have a valid APC. Problems with APC renewal aren't new, with previous delays up to March.

16 December 2025

Malaysia

Perdim Recalls Failed TPA Venture, Wants TPAs Regulated

Perdim says establishing a doctor-led TPA is difficult due to high costs, manpower needs, and business risks; its MyTPA venture collapsed in 1.5 years. Rather than doctor groups forming their own TPAs, Perdim demands a new Act to regulate ITOs/TPAs/MCOs.

9 December 2025

Malaysia

Year Of The Doctor: Recapping Malaysian Health Care In 2025

2025 is the Year of the Doctor in Malaysian health care, with policies favouring medical practitioners across public/private: 40% ETAP allowance hike for medical officers, MOH defending doctors in health insurance issues, and drug price display deferral.

1 December 2025

Malaysia

Managed Care ‘Achieves’ Lower Costs By Restricting Care, Says FPMPAM

FPMPAM says subjecting referrals, investigations, and medication choices or even quantities to TPA approval is "intrusion" into clinical decision-making, "not benefit management". Managed care supposedly "achieves" lower costs by restricting care.

28 November 2025

Malaysia

A TPA’s Medical Trend: Average RM9,300 Hospitalisation, RM131 GP Visit

PMCare, a TPA, reported average cost per visit/admission in 2024 at RM9,289 for hospitalisation, RM526 for specialists, and RM131 for GPs. Medical cost inflation under 1% for hospitalisation in 2024. Average GP cost: RM134 (RM100 meds + RM34 consultation).

27 November 2025

Malaysia

PMCare Wants Act To Regulate TPAs Under MOH

PMCare calls for a standalone Act to regulate TPAs and MCOs that should set out an operational framework, including payment terms for panel providers and definitions of "clinical interference". PMCare wants TPA regulation to be under MOH's jurisdiction.

Tag: third party administrators (TPAs)

Balancing Financing And Patient Care: Accelerate Regulating TPAs And MCOs — Dr James Jeremiah

Interfering With Medical Practice May Be Illegal, MOH Warns TPAs

PAC Report Confirms Need For Urgent Regulatory Reforms In Private Health Care

Health Ministry Threatens Enforcement Action Against Doctor Fee-Splitting

PMCare To Honour Claims By Panel Doctors Without Valid APC

Perdim Recalls Failed TPA Venture, Wants TPAs Regulated

Year Of The Doctor: Recapping Malaysian Health Care In 2025

Managed Care ‘Achieves’ Lower Costs By Restricting Care, Says FPMPAM

A TPA’s Medical Trend: Average RM9,300 Hospitalisation, RM131 GP Visit

PMCare Wants Act To Regulate TPAs Under MOH

Time For Doctors To Relinquish Management Of The Health Service

JPA Refuses To Further Relax LNPT Requirement For Subspecialty Training

Stool Tests Cannot Replace Diagnostic, Preventive Colonoscopy: Specialists

Malaysia Heading In US Direction With MediAsas: Expert