GURUGRAM, October 1: The Haryana government has ordered an audit of private hospitals empanelled under the Pradhan Mantri Jan Arogya Yojana (PM-JAY) to determine whether beneficiaries are being charged separately for medicines, consumables, procedures or hospital services that are already included in government-notified treatment packages.
The Director General of Health Services has directed civil surgeons across Haryana to examine billing practices at empanelled hospitals in their respective districts and submit compliance reports within 30 days.
Private Hospitals Across Haryana to Face Scrutiny
The verification exercise will examine bills raised by private hospitals participating in the government healthcare system.
Officials have been instructed to compare hospital bills with government-approved package rates and determine whether patients were charged additional amounts for services that should already have been included in the prescribed package.
Civil Surgeons Asked to Submit Reports Within 30 Days
Civil surgeons in every district have been tasked with carrying out the verification exercise.
They will examine hospital records, bills, package rates and relevant documents before submitting their findings to the state health authorities.
The 30-day deadline is intended to ensure that the review is completed in a time-bound manner.
Audit Follows Punjab and Haryana High Court Direction
The verification exercise follows a May 5 judgment of the Punjab and Haryana High Court in the case of Hukam Singh vs State of Haryana & Others.
The court had directed the state to verify whether empanelled hospitals were following prescribed package rates and to take corrective action wherever violations were detected.
It also stressed that patients or their family members should be informed about treatment costs in a language they understand.
Medical Bills and Package Rates to Be Compared
Health officials will examine medical bills issued to beneficiaries and compare them with government-notified treatment packages.
The review will determine whether the approved price for a procedure was followed and whether medicines, consumables or other services included in the package were charged separately.
Hospitals may be required to provide complete records if discrepancies are identified.
Government Targets Artificially Low Package Quotations
The Health Department has specifically asked officials to identify cases where hospitals may have quoted a lower package price initially and subsequently charged patients separately for essential components.
Such practices could make an apparently cheaper treatment package more expensive once medicines, procedures or consumables are billed separately.
The government has made it clear that essential components already included in a notified package should not be charged again.
Medicines and Consumables Included in Package Under Review
Officials will check whether hospitals have separately billed for medicines and consumables already covered under the applicable package.
Government treatment packages can include multiple components rather than only the primary surgical or medical procedure.
The verification exercise is therefore expected to look at the complete hospital bill rather than only the headline treatment charge.
Hospital Services and Procedure Charges Also Covered
The audit will also examine charges relating to hospital services and procedures.
Under Haryana’s existing medical reimbursement framework, package rates can include components such as admission charges, consultations, investigations, surgical procedures, anaesthesia, operation theatre charges, nursing care and other treatment-related expenses.
Hospitals are expected to follow the applicable government-approved rates and conditions.
Higher Room Category and Costlier Implants to Be Checked Separately
The government has recognised that some patients may voluntarily choose services beyond their entitlement.
These could include a higher room category or implants costing more than the government-approved amount.
In such cases, hospitals are required to obtain the prescribed undertaking from the beneficiary, and officials will check whether proper documentation was completed.
Officials to Determine Whether Extra Charges Were Permissible
Not every additional payment will automatically be treated as overcharging.
Officials will determine whether a separately billed service genuinely falls outside the notified treatment package and whether charging for it is permitted under government rules.
The circumstances of each case and supporting documentation will therefore form an important part of the audit.
Patients Must Be Told Treatment Costs Clearly
Hospitals will also be assessed on whether they properly informed patients or their family members about treatment costs.
Information about what is included in the government package and what, if anything, must be paid separately should be communicated in a language familiar to the beneficiary.
The requirement is intended to reduce confusion and unexpected expenses during hospitalisation.
Hospitals May Have to Provide Written Compliance
Empanelled hospitals will be required to confirm that they will follow notified package rates and avoid separately charging patients for components already included in those packages.
Where officials identify questionable billing, hospitals may be asked to provide explanations and supporting records.
The exercise is expected to create greater accountability in the billing process.
Refund Possible Where Overcharging Is Established
If an investigation establishes that a beneficiary was improperly charged, authorities may initiate appropriate action against the hospital.
This could include directing the hospital to refund excess amounts collected from the patient wherever applicable.
Additional action could also be considered depending on the nature and seriousness of the violation.
Haryana Has Package Rates for Around 1,340 Treatments
Haryana has notified package rates covering approximately 1,340 treatments, including approved rates for implants and other treatment components.
These package rates are intended to provide a standardised framework for treatment costs under applicable government healthcare arrangements.
The current verification exercise will examine compliance with these existing rates.
Audit Is Not a Revision of Treatment Rates
The Health Department has clarified that the exercise is not intended to revise existing package rates.
Instead, authorities are examining whether hospitals are adhering to rates and conditions that have already been notified.
Any wider revision of treatment prices would be a separate policy process.
PM-JAY Designed to Provide Cashless Hospital Treatment
PM-JAY provides eligible families with cashless access to specified secondary and tertiary hospital care through participating public and private hospitals.
Covered packages can include treatment, consultation, medicines, medical consumables, diagnostic investigations, hospital accommodation and other specified expenses.
The scheme is designed to reduce the financial burden of hospitalisation for eligible beneficiaries.
Audit Aims to Protect Beneficiaries From Unexpected Bills
The Haryana government’s latest exercise will focus on whether the cashless and package-based nature of covered treatment is being properly followed by empanelled private hospitals.
With civil surgeons required to report within 30 days, authorities are expected to identify billing irregularities and take corrective action where violations are established.
The findings could also help strengthen monitoring of private hospitals participating in government healthcare programmes.
Source – Haryana Health Department / Ayushman Bharat Haryana / Times of India The Times of India
Supreme News Network
