Private Hospitals Annoyed Over Unpaid Dues, Threaten to Stop Cashless Services

Private hospitals have pressurised to stop providing cashless treatment benefit under CGHS (Central Government Health Scheme) and ECHS (Ex-Servicemen Contributory Health Scheme).

The private hospitals association has decided to call off offering cashless treatment benefit under CGHS and ECHS as they already have a pending bill worth Rs. 1,600 Crore pending with the Ministry of Finance.

A letter to draw the attention towards pending bills was sent in July to the Ministry of Finance, but not much has been changed since then. What it has resulted in instead is the private hospitals panicking, which might affect the beneficiaries under these schemes which are nearly a Crore in number.

The Association claims that pendency has only worsened since Ayushman Bharat and PMJAY (Pradhan Mantri Jan Arogya Yojana) schemes launched by the Modi government.

AHPI (The Association of Healthcare Providers in India) has planned to call off cashless service under CGHS and ECHS if the centre does not clear pending bills.

The Director-General of AHPI, Dr. Girdhar Gyani says, “The pending bills have been accumulating over the past three years as the number of hospitals covered under these schemes has gone up while the periodic budget to clear bills continues to be the same”. He added, “The situation has worsened since the launch of Ayushman Bharat and the pending bills are now close to Rs 1,600 crore. He further added, “We are going to soon write to the ministry and intimate the officials that we will be forced to stop cashless service as an emergency measure to cap our growing losses”.

Memorandum to Ministry of Finance

In this letter, AHPI said that the scheme is losing attention among the healthcare providers as well as policyholders because of long pendency of dues.

Payments

The major concern is reimbursement to the hospitals. Hospitals had to sign an agreement on the basis of terms and conditions specified under CGHS, with effect from 1st October 2014. It allows the beneficiaries to pay 70% of the total amount within 5 working days after submission of bills by the hospitals.

However, in no case, the payment has been made within this stipulated time frame.

Hospitals have no choice so they keep on waiting for months and even years to get the dues cleared. This has led to a situation where the hospitals have started refusing or avoiding the beneficiaries for cashless treatment.

AHPI gave a warning in the letter that the outstanding amount will continue to be in the same bracket until the ministry releases the pending amount. "We would be grateful if you could look into this long-pending issue, which is making hospitals unsustainable, this has also impact on flagship scheme PMJAY under Ayushman Bharat as hospitals are vary of joining government schemes for same fear of not getting timely reimbursements," says AHPI.

Pending bills of some hospitals, for instance, Max Healthcare have been added more than Rs. 150 Crore and Fortis has been added to around Rs. 58 Crore.

Pointing at the other side of the story, Abhay Shukla, the national convener of Jan Swasthya Abhiyan says, “The hospitals should also stop arbitrarily overcharging patients who are not covered by any insurance or schemes.”

The impact

If the decision of private hospitals if implemented will affect nearly 37 Lakh central government employees, pensioners, and the dependents, and more than 52 Lakh ex-servicemen dependents under ECHS in more than 1,000 hospitals and nursing homes offering healthcare services.