Ayushman Bharat scheme: Private hospitals refuse cashless treatment, ‘clear Rs 600 crore dues first’

The PHANA announced their decision in Ludhiana, stating “the SHA has not cleared the outstanding payment pending with them for over six 6 months”. Reacting to minister’s statement, PHANA stated that this amount is of the pending claims prior to February, 2024.

Ayushman Bharat scheme offers cashless treatment up to Rs 5 lakh per family per year in as many as 772 government and private empanelled hospitals in Punjab. The SHA has issued 84.44 lakh cards to over 45 lakh families in the state, offering access to around 1,600 types of treatments, including knee replacements, heart surgeries, cancer treatments, etc, a government statement said.

“The association apologises to the people of Punjab for the move, but hospitals are now deeply in debt due to non-payment of dues,” PHANA honorary secretary Dr Divyanshu Gupta told The Indian Express.

Gupta said, “As per the 2011 Census, there are 65 lakh families, out of these Ayushman health cards have been given to 45 lakh families. However, only 13 lakh families are Below the Poverty Line (BPL) and come under the Socio-Economic Caste Census (SECC) data card, as per the 2011 Census. They issued blue cards to BPL families. The Centre contributes 60 per cent of the share for these 13 lakh families and the remaining 40 per cent is of the state, while the remaining 32 lakh cards were made by the state government. Now, nearly 69 per cent of Punjab households have Ayushman health cards, enabling them to take cashless treatment up to Rs 5 lakh in empanelled hospitals. As the state government is not making timely payments, how will these hospitals survive?”

Chairing a review meeting of the SHA sub-committee in Chandigarh on Wednesday to discuss policy-related matters, shortage of manpower and various other ongoing issues, the Health Minister directed the officers concerned to clear the pending payments to all hospitals, which are empanelled under the Ayushman Bharat Mukh Mantri Sehat Bima Yojana.

“The recruitment drive will focus on qualified medical professionals who can effectively assess and process claims, thereby facilitating prompt reimbursements to healthcare providers. The newly appointed staff will undergo comprehensive training focused on the protocols and requirements specific to the claim processing system,” the minister added.

Administrative Secretary, Health, Kumar Rahul, Member of the Punjab Development Commission Anurag Kundu and SHA CEO Babita attended the meeting.

Notably, the SHA CEO on September 11 issued a letter to the deputy medical commissioners (DMCs) in 23 districts to take strict action against hospitals taking money but denying services to the patients. The SHA has sought a detailed inquiry report within three days of such incidents and directed the DMCs to get the money refunded to the patients.

The association said PHANA representatives had previously held discussions with the SHA CEO and the Health Minister to resolve the payment issue but no action was taken despite repeated assurances of payment clearance within 15 days. “Several hospitals have sent around 300 emails in the past six months, but rather than making payments, the SHA is ordering action against hospitals,” Dr Gupta said.

PHANA president Dr Vikas Chhabra said, “The SHA has violated the Memorandum of Understanding (MOU) by delaying payments and has no legal right to take action against hospitals for denying services.”

“Several hospitals are struggling to pay their staff and suppliers. They are taking loans to cover operational costs. Medicine and implant vendors have halted supplies due to unpaid dues. The recent MSME rules require hospitals to clear vendors’ payments within 15 days, exacerbating their financial strain,” Dr Chhabra added.

The association demands 100 per cent clearance of all pending payments immediately, introduction of 1 per cent interest on delayed payments beyond 15 days, de-reservation of treatment packages to allow private hospitals to provide essential services to all residents of Punjab without discrimination, establishment of a hospital grievance redressal system and verification of complaints before initiating action against hospitals with penalties for alleged false complaints, among others.