THE BMC has inspected 6,851 hospital bills amounting to Rs 112 crore since the Covid-19 outbreak began and reduced or made hospital refund bills to worth Rs 14 crore. Of 7,145 inquiries or complaints against hospitals, 294 were of overcharging.
The issue of high treatment costs was raised right after the first Covid-19 cases surfaced in Mumbai. The city has, so far, recorded 2.45 lakh Covid cases, second only to Delhi in India. Every day, 150 to 200 people seek hospitalisation.
A scrutiny by The Indian Express of hospitals bills and of notifications introduced by BMC and state government at regular intervals shows how hospitals and the BMC continued to play cat and mouse.
As the government capped the price on some billing components, hospitals added new ones, said auditors appointed by the BMC. The civic body has deputed five IAS officers and 17 auditors to monitor private hospitals.
“Where the government could regulate prices, it did, but components like medicines and investigations are left to the doctor’s discretion. In this, we find hospitals overcharging. If one drug is injected, hospitals charge for the entire strip; if one PPE (personal protective equipment) by doctors or nurses is used for 10 patients in a ward, each patient is billed for a piece instead of the cost being divided,” said Prashant Nanaware, who audits five private hospitals in the western suburbs.
The maximum number of complaints of overcharging are against Wockhardt hospital (38), Bhatia hospital (34), Kohinoor hospital (21), Apex (18), Saifee (18) and Nanavati (17).
At the end of April, a bill from Wockhardt hospital priced an entire PPE suit with goggles and gloves at Rs 8,000 per patient per day. The PPE accounted for 10 per cent of the total bill. Similar complaints came from other hospitals.
On April 30, the state government capped prices of consumables like PPE at 10 per cent mark up on net procurement cost. A grievance system through e-mail was created for patients to complain against overcharging, while the state also capped the cost of several surgical procedures.
But complaints of overcharging on new components came up. On July 15, Niron hospital charged a 62-year-old woman Rs 3,000 per day for oxygen for 15 days, although a state government analysis showed it cost a hospital Rs 300 to Rs 400 per day to put a patient on oxygen support.
According to auditors, hospitals also showed that they were procuring PPE at high cost to justify their bills. In July, the BMC was forced to register an FIR against Nanavati hospital for overcharging a female patient over PPE and treatment. “The FIR was a warning for other hospitals,” Nanaware said. Nanavati hospital refused to comment.
In the same month, the BMC de-listed Apex hospital’s Borivali centre from Covid treatment following overcharging complaints.
On August 31, the state government issued a new notification asking hospitals to include oxygen as part of bed cost and to cap PPE at Rs 600 in a normal ward, and at Rs 1,200 per patient per day in an ICU.
A state heath official said in August and September, hospitals began charging patients for HRCT scan, medical waste management, fumigation and patient hygiene. In two bills, Apex hospital charged Rs 400 for handling of biomedical waste per patient, Rs 1,000 for patient hygiene and Rs 300 for fumigation per day.
“I don’t know what hygiene charges are. They never scrubbed or touched me in the ward. In ICU, the only patient hygiene facility provided was a bed pan,” said Tushar Garg, a Covid-19 patient admitted for seven days at Apex. Garg approached the BMC and the hospital agreed to deduct Rs 40,000 from the bill last week.
Vivek Singh from the Apex administration said all complaints of overcharging had been resolved.
In mid-August, the BMC de-listed 72 nursing homes from Covid treatment. “That was a fallout of exorbitant billing. Smaller hospitals were profiteering from patients,” a senior BMC official said. By September, however, 23 nursing homes were roped back in for Covid treatment with a strict warning. Additional Municipal Commissioner Suresh Kakani said, “Shutting down hospitals is not the solution. We want to work with them, not against them.”
Dr RB Dastur, medical director of Bhatia hospital, said price capping was introduced without consulting hospitals. “Our hospital spends Rs 18.5 lakh for PPE per week. We are unable to recover that amount due to price capping. Since the notification was released, we have been following government norms.”
Dastur added that monthly salary to the ICU staff had risen by Rs 9 lakh due to four shifts instead of three during the pandemic. “These are additional costs that the hospital is handling,” he said.
A spokesperson from Wockhardt hospital said they had treated 2,300 Covid patients and had a 4 per cent mortality rate. “Evidence-based treatment protocols of the hospital have helped to expedite and restore normalcy in complicated and co-morbid patients,” the spokesperson said.
On September 24, the state capped HRCT test bringing it down to Rs 2,000 to Rs 3,000. Next day, convalescent plasma was capped at Rs 5,500 per unit.
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