Auditor-General reveals miscalculation of Medifund assistance for B2 wards in 2018/19 annual report

The Auditor-General’s Office of Singapore recently released 2018/19 annual report reveals a miscalculations of Medifund assistance for B2 wards since 2013. One hospital in particular handed out an extra S$119,100 in assistance between April 2017 to March 2018.

The report, which presents audit findings on a broad swathe of agencies, ministries and bodies of the government, notes that the AGO covered two areas in scrutinising Medifund: administration and disbursement of assistance.

According to the report, checks by the AGO have revealed that “a restructured hospital (RH) did not compute Medifund assistance for recipients who chose to stay in class B2 wards, in accordance with the guidelines in the Medifund manual issued by the MOH.” As a result, the RH granted higher Medifund assistance than was provided for in the manuals.

These checks revealed that the difference amounted to S$119,100 for 24 bills for 22 recipients who chose to stay in B2 wards at the RH in question between 1 April 2017 to 31 March 2018.

As elaborated in the report, the hospital informed the AGO that it had been using that approach to calculate the Medifund assistance amount for B2 wards since 2009. Based on the AGOs audit, the MOH estimated that there could be approximately 4,500 miscalculated Medifund assistance handed out for class B2 wards in that hospital between 2013 to 2018.

Surprisingly, the report also revealed that MOH has been aware since 2015 that there were other public healthcare institutions as well using the same erroneous computation as the RH to calculate Medifund assistance for recipients in B2 wards.

The report highlighted that the different approaches in these calculations across public healthcare institutions in the country would result in an ‘inconsistent treatment of Medifund recipients’.

According to the AGO, MOH has acknowledged that “it had not been sufficiently clear or timely in rectifying the misunderstanding by the RH in the computation approach”, adding that while Medifund is a discretionary safety net with decentralised assessments and decision-making at institutions, the guidelines on the computations should be clearly communicated.

The report concludes by saying that MOH informed the AGO that it will not be recovering the difference in Medifund assistance wrongly handed out from the RH or other public healthcare institutions as the Medifund manual was merely a guideline, not a strict rule. MOH said that “the institutions had assessed the recipients to be in significant financial difficulties”.

Moving forward, however, the AGO reports that MOH assured it will ensure greater clarity and consistent understanding of the guidelines in the Medifund manual.

Having said that, MOH reminded all institutions involved to apply the guidelines on calculations of assistance more consistently while waiting for the ministry to implement new billing system with a consistent computation approach by the end of 2019.

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