ECHS functioning- Pvt hospitals overcharging from ECHS patients: CAG report

THE COMPTROLLER and Auditor General (CAG) has found large-scale anomalies in the manner in which the Ex-servicemen Contributory Health Scheme (ECHS) is being run under regional centres falling under the Western Command, including inflated billing by private hospitals and failure to keep a check by ECHS centres. The report, which was recently made public, gives […]

Written by Man Aman Singh Chhina | Chandigarh | Published: December 26, 2015 10:28 am

THE COMPTROLLER and Auditor General (CAG) has found large-scale anomalies in the manner in which the Ex-servicemen Contributory Health Scheme (ECHS) is being run under regional centres falling under the Western Command, including inflated billing by private hospitals and failure to keep a check by ECHS centres.

The report, which was recently made public, gives examples to show that higher rates were being charged by private hospitals empanelled to treat veterans under ECHS.

In an example, the report says that on comparison of bills of ECHS and non-ECHS patients pertaining to Fortis Hospital, Mohali, it was found that the rate of Total Knee Replacement (Bilateral) charged by the hospital from ECHS patients was higher than that charged from the non-ECHS patients.

This had resulted in excess payment of Rs 99.49 lakh between April 2012 and October 2014. The report says that the MD, ECHS, explained in October 2015 that Fortis Hospital, Mohali had informed that their charges for bilateral total knee replacement for general public were higher than ECHS beneficiaries.

“The reply is not factually correct as it was seen from the actual bills raised by the hospital in respect of ECHS and non-ECHS patients that the amount charged for the procedure (excluding implants and bone cements) from ECHS patients was more than non-ECHS patients.” the report said.

The CAG found several examples where patients were seen to be admitted in two different hospitals during the same period of time. It was also found that the regional centre in Chandimandir had failed to establish checks in the system which could validate such claims.

A scrutiny of records of regional centre Chandimandir found that a patient who claimed that he was admitted in Silver Oaks Mohali during a period of time was also found to be admitted in Max Super Speciality Hospital during the overlapping dates.

In another instance, a patient was stated to be admitted in Grecian Super Speciality Hospital in Mohali between October 1, 2012 and October 8, 2012 while he was also shown to be admitted in Fortis Hospital Mohali from October 5 to October 8, 2012. At least 15 such cases pertaining to regional centres of Chandimandir and Jalandhar were found.

The CAG report has also revealed that the MRP rate charged by the empanelled hospitals were considerably higher than the discounted rates available in the local markets.

During an audit at regional centre, Jalandhar, the CAG audit team found that while empanelled hospitals under the centre had charged between Rs 9,175 and Rs 18,880 for Injection Peginteraferon Alpha 2a and b22 (Roche), the same injections had been procured by Military Hospital Jalandhar during the same period in 2014-15 for Rs 3,543 to Rs 5,670. This differential in cost resulted in extra expenditure of approximately Rs 89.53 lakh.

The report states that as per the memorandum of agreement between ECHS and empanelled hospitals, it was stipulated that the hospitals would not charge more than the MRP for medicines. “We saw that the empanelled hospitals were charging the cost of medicine at MRP in their bills and the same were paid by ECHS,” the report says.

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