The moral compass of the elites

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8 telehealth providers investigated by MOH for lapses​

Enforcement action has been taken against three of the providers, including MaNaDr Clinic.ST PHOTO: LIM YAOHUI

Lee Li Ying
Jan 08, 2025

SINGAPORE – Eight telemedicine providers have been or are currently being investigated for lapses in clinical care or inappropriate advertisements of services, said Senior Minister of State for Health Janil Puthucheary in Parliament on Jan 7.

Enforcement action has been taken against three of the providers, including MaNaDr Clinic, Dr Janil added.

MaNaDr Clinic was found to have more than 100,000 teleconsultations that lasted one minute or less in a sampled month, among other lapses. The Ministry of Health (MOH) revoked the clinic’s licence on Dec 20, 2024, barring it from providing outpatient medical services.


Responding to parliamentary questions on whether there are similar trends of unethical telehealth providers following the MaNaDr case, Dr Janil said that the eight telemedicine providers have been or are being investigated for non-compliances in two categories.

The first is in clinical care, such as doctors issuing prescriptions and medical certificates without proper clinical assessment or not conducting video consultations for first-time patients.

The second is for inappropriate advertisements, such as those promoting the unnecessary use of telemedicine services.

The actions taken include a short suspension and a stern warning, commensurate with the severity of the breaches, said Dr Janil.

In addition, medical practitioners have been referred to the Singapore Medical Council for potential lapses in professional standards. The council’s review is under way.

He did not name the other operators as investigations are still ongoing.


In 2024, MOH received 59 complaints regarding telemedicine involving 20 operators.

There were a number of licensees involved and there were “some very short teleconsultations”, said Dr Janil, adding that the ministry is trying to establish what the exact numbers are.

He pointed out that a short teleconsultation is not automatically incorrect if it is with a regular patient, or a follow-up, or if necessary information has been obtained.

“We have to look at the entire clinical care that has been provided and make sure it’s appropriate. It’s not the fact of telemedicine that is necessarily wrong, it’s whether correct clinical care has been provided through this modality, and that sometimes requires inpatient consultation,” said Dr Janil.

“Sometimes, it requires the appropriate breadth and time for the interactions so that correct information is provided. And in some cases, it is an issue of whether or not the correct documentation of the process has been carried out. So all of these things are part of the investigation process.”


Responding to a question on how telemedicine may be abused to get easy access to medical certificates, Dr Janil pointed out that such inappropriate behaviour can happen in an in-person setting as well.

When it comes to telemedicine abuse, there are a variety of things that the ministry looks at, which include metrics in terms of the numbers, the patient mix and the justifications for the medical certificate or any other therapeutic intervention.

“Ultimately, has a correct assessment been provided? And is the treatment – whether it is medication, investigation or medical certificate – appropriate to the medical condition that has been detected and appropriately documented?”

Dr Janil said it is important to recognise that telemedicine can bring tremendous benefits to patients, especially those who are immobile or doing regular follow-ups. It makes healthcare much more accessible and convenient to patients.

“However, as in any new service delivery model, there will be abuse and misuse, especially in the initial period of implementation. MOH will take the necessary enforcement action, (so) that over time, best practices become normalised.”

The public can raise concerns on the provision of telemedicine via e-mail at [email protected]

 

[True Believer]

We are in a vicious cycle of doctors chasing higher operating costs in private practice and passing on such expenditure to their patients. An increasing number of doctors in private practice seem unperturbed with the appropriateness of their relationship with drug manufacturers. It would be naïve to believe that any business would discourage its sales reps from doing all it takes to establish strong relations with customers, who are likely to give the highest return on their investment, in entertainment and other payments in kind.

 

[True Believer]

On the issue of prescriptions, doctors in the public sector generally feel no direct impact from the sale of drugs. Specialists in premier private hospitals, on the other hand, treat affluent local patients or medical tourists, who have more options when it comes to their treatment plan, as well as the purchasing power to obtain patent drugs. Even though not all doctors are easily swayed by incentives from pharmaceutical companies into handing out more prescriptions than are necessary, the crux of the matter is that this mutually beneficial relationship between drug manufacturers and doctors is undoubtedly a conflict of interest in medical practice.

 

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Telehealth provider MaNaDr admits to lapses that led to revoking of clinic licence​

MOH had revoked the licence of MaNaDr Clinic at City Gate in Beach Road more than three months ago.

Apr 02, 2025

SINGAPORE – MaNaDr has admitted that there were lapses in its services and introduced new safeguards following concerns over the improper use of its telehealth platform.

This comes more than three months after the Ministry of Health (MOH) revoked the licence of MaNaDr Clinic at City Gate in Beach Road, which halted all of its operations, including outpatient services at the clinic and temporary premises such as patients’ residences, as well as teleconsultations.

MaNaDr chief executive and founder Siaw Tung Yeng said during a media briefing on April 2 that the firm “could have done a better job” of preventing abuse of its telemedicine services, but did not explain how the lapses occurred.

“We are more committed than ever to creating a safe, ethical and effective platform to rebuild patients’ trust in telemedicine,” he said. Dr Siaw also did not specify if the firm is seeking recertification from MOH, only telling The Straits Times that opening a new clinic will be a “business decision”.

“Ultimately, that is not our main business, our business is in innovation and technology… The clinic at City Gate was just a place where we could pioneer our innovation.”

Investigations by MOH found that a very large number of cases seen by MaNaDr Clinic doctors involved very short teleconsultations with video calls that lasted one minute or less, but nevertheless concluded with the prescription of medication and issuance of medical certificates (MCs).

Following such short teleconsultations, MOH found that some patients were issued multiple MCs over a few different teleconsultations within a short period of time, for example, within 30 days.

In some instances, patient case notes contained detailed information that was not commensurate with the short duration of the teleconsultation. Conversely, in other instances, patient case notes were extremely sparse or brief, which potentially compromised the continuity of patient care.

Dr Siaw said the firm has since introduced several safeguards to its telehealth services, including artificial intelligence tools that transcribe doctor-patient conversations, a timer to prevent overly short consultations, and increased training and audits of doctors and clinics using the platform.


Checks by ST found that teleconsultations are still being conducted on the MaNaDr app through other clinics and service providers with their own remote licence.

Dr Siaw said “around 50 to 100” clinics continue to use the MaNaDr app, but declined to provide a specific figure. ST understands this represents a drop of more than half in the number of clinics using the platform.

MaNaDr sits under the holding company Mobile-health Network Solutions, which went public on the US’ tech-heavy stock exchange Nasdaq in April 2024.

Dr Rachel Teoh, co-founder of Mobile-health Network Solutions, said that funds raised from the initial public offering will continue to help MaNaDr’s expansion into regional markets such as Indonesia, Thailand and Australia.

She said that these markets will follow the firm’s business model in Singapore, which includes three key areas: telemedicine services, a wellness marketplace on the MaNaDr app offering access to mental health support and medical products, and an operating system for healthcare providers that features a clinic management platform.

Shares of Mobile-health Network Solutions have fallen more than 96 per cent in the past year to hit US$1.89 on April 1.

 

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Forum: Ultra-short teleconsultations can’t ensure quality of medical care​

Apr 08, 2025

The recent revocation of MaNaDr Clinic’s licence by the Ministry of Health underscores the importance of maintaining rigorous standards in telemedicine practices (

Telehealth provider MaNaDr admits to lapses that led to revoking of clinic licence, April 2).

Investigations revealed that a very large number of teleconsultations by MaNaDr Clinic doctors involved very short sessions on video call that lasted one minute or less. Such practices raise significant concerns about the adequacy of patient evaluations and the justification for subsequent prescriptions and medical certificates.

While not every consultation requires a lengthy discussion, a one-minute consultation – whether in person or virtually – is not acceptable and falls short of professional expectations.


Even when patients present with seemingly straightforward issues, a good family medicine consultation should always consider the broader context of the patient’s health.

This includes chronic disease management, lifestyle advice, opportunistic screening, and efforts to shape positive health-seeking behaviour. A consultation concluded in mere seconds or a minute is a missed opportunity to provide holistic, patient-centred care, which is fundamental to the practice of family medicine.

Moreover, a teleconsultation must not be treated as a shortcut. It demands the same standards of care as an in-person visit. This includes taking a proper history, reviewing symptoms thoroughly, arriving at a reasonable diagnosis, and ensuring the patient understands the management plan. Omitting these essential steps puts patients at risk of misdiagnosis, unsafe prescriptions, and delayed treatment of serious conditions.

The Singapore Medical Council’s Ethical Code and Ethical Guidelines are clear: Doctors are duty-bound to deliver competent, compassionate and appropriate care.

Ultra-short consultations also breach core ethical principles such as beneficence (the duty to promote the patient’s well-being) and respect for patient autonomy (by providing enough information for patients to make an informed decision).

As we embrace technology in medicine, doctors must hold fast to their professional and ethical responsibilities. Telemedicine can greatly improve access to care, but it must be delivered with the same diligence, care and thoroughness as face-to-face consultations.


Wong Tien Hua (Dr)
President
College of Family Physicians Singapore

 

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MaNaDr must ensure regulatory compliance regardless of its corporate structure: MOH​

MaNaDr Clinic’s licence was revoked on Dec 20 last year after MOH’s investigations discovered lapses in its operations.

Apr 09, 2025

SINGAPORE - The Ministry of Health (MOH) has responded to claims made by MaNaDr chief executive Siaw Tung Yeng about the firm’s corporate structure.

Dr Siaw had told the media on April 2 that MaNaDr Clinic operates independently as a subsidiary of its holding company Mobile-health Network Solutions and manages its own clinic operations.


MaNaDr Clinic’s licence was revoked on Dec 20, 2024, after MOH’s investigations discovered lapses in its operations, including numerous cases of very short teleconsultations lasting one minute or less, which still resulted in prescriptions and medical certificates.

MOH said that under the Healthcare Services Act (HCSA) 2020, all licensees and their key office holders are ultimately responsible for ensuring compliance with regulatory requirements, regardless of the licensee’s corporate structure.

“Licensees are also fully accountable for the safety and quality of the healthcare services provided by the clinic, including telemedicine services, and must ensure that the services comply with the applicable ethical and professional standards,” it said in the statement released on April 9.

During the media briefing on April 2, Dr Siaw said that MaNaDr’s clinic operations and its telemedicine platform MaNaDr are separate businesses that run independently of each other under the company Mobile-health Network Solutions. He was responding to queries about why the lapses were not detected earlier.

MOH noted that as the principal officer and clinical governance officer of MaNaDr Clinic, Dr Siaw would have been responsible for the day-to-day management of the clinic and provision of clinical governance and technical oversight over the clinic’s services.

“Any doctor who practises under the auspices of a licence under HCSA, whether as a locum practitioner or an employee, does not operate independently, but must be under the supervision and oversight of the licensee and their key officeholders,” the MOH statement added.

Dr Siaw also said on April 2 that MaNaDr has introduced several safeguards to its telehealth services, including a one-minute minimum for consultations before issuing medical certificates, artificial intelligence (AI) tools to transcribe doctor-patient conversations, and enhanced training and audits for doctors and clinics using the platform.


On the length of teleconsultations, MOH said it is not necessarily the case that so long as a teleconsultation exceeds a minute, it would pass muster.

“The duration of the teleconsultation should be commensurate with the patient profile and presenting medical conditions, as reflected in the Singapore Medical Council’s Ethical Code and Ethical Guidelines,” it noted in the statement.

“Licensees providing teleconsultations are required to put in place quality assurance measures such as implementing and regularly reviewing protocols and processes to ensure that doctors are conducting proper clinical assessments and prescribing and issuing medical certificates on proper medical grounds.”

The ministry also pointed out that while the use of AI in clinical settings can enhance efficiency and has the potential to improve patient outcomes, it also brings about “inherent risks and ethical concerns”.

It reminded licensees that, even with the use of MaNaDr’s AI tools, they remain responsible for complying with HCSA requirements, including ensuring patient safety and welfare for all services provided. For example, where AI-powered tools are used for transcribing interactions between doctors and patients or consolidating prescribed treatment plans, licensees must ensure the accuracy, confidentiality and security of the patient health records.

“Licensees must also check if the AI tools need to be registered with the Health Sciences Authority as a medical device, and ensure that fair and non-biased data was used to train the AI tool,” it said.


Checks by The Straits Times on April 2 found that teleconsultations were still being conducted on the MaNaDr app through other clinics and service providers with their own remote licence.

The MaNaDr telehealth platform provides healthcare services via its network of 700 clinics and more than 1,500 medical professionals in Singapore.

It was the largest telehealth solutions mobile application in Singapore, based on the number of user consultations per day in the six months ending May 2023.