CGHS beneficiaries suffer as Govt is yet to clear funds meant for approved private hospitals

CGHS beneficiaries suffer as Govt is yet to clear funds meant for approved private hospitals – Employees referred to other hospitals by empanelled hospitals as Payment for the last three months pending

The Central Government Health Scheme (CGHS) is sitting on funds to the tune of Rs. 400 crore, meant to be disbursed among private hospitals as part of pension scheme.

According to sources, CGHS officials have not been able to clear the pending funds, leading to delay in treatment of patients too. The officials at CGHS had earlier appointed a third party administrator to reduce the waiting period to reimburse the bills. In 2011, the central agency entered into an MOU with top corporate hospitals, pooling in UTI Infrastructure Technology and Services Limited (UTISL), to ensure bills will be cleared in 10 days after the submission.

Officials at the department said that CGHS is yet to receive the funds worth Rs.300 crore from UTI. These funds are pending with UTI Infrastructure Technology and Services Limited (UTISL), which has not been reconciled since last three years.

“It was decided that 10 per cent of every bill will be kept with UTI and rest will be paid to the hospitals as part of reimbursement scheme. No one has bothered to clear the bills. Later in 2014, the rates were revised and it said that 10 per cent of amount will not be deducted and 70 per cent of the amount will be paid to the service provider,” a source in the Ministry of Health and Family Welfare told Mail Today. Now, as the previous funds have not been cleared, the CGHS in its latest auditing found that around Rs.117 crore is also pending. These funds have been reconciled but not released as the third party has not cleared the previous dues. “The amount has accumulated to more than Rs.400 crore and authorities at CGHS are perplexed, as how to distribute the funds. We have been requesting the officials to clear the same but they are not taking the matter seriously,” said a private hospital official while requesting anonymity.

The “Central Government Health Scheme” (CGHS) provides comprehensive healthcare facilities for the central government employees and pensioners and their dependents residing in CGHS covered cities. Due to lack of qualified doctors to properly vet the medical bills, the reimbursement process used to get delayed inordinately.

Private hospitals have not received the payment for the last three months. At the end, it’s the patient who suffers. According to various private hospitals, the CGHS has not released the amount for the last three months.

“We have not received the reimbursements from the central agency. Left with no other option, we are referring patients to other hospitals. The amount due is in crores and we cannot allow them to continue in this way,” one of the directors of a private hospital told Mail Today.

When Mail Today contacted N.S. Kang, additional secretary and DG, he said: “I am out of station and cannot comment on the issue right now.”
Source: India Today