CGHS Empanelled hospitals claim unpaid dues and stop providing cashless services to beneficiaries

Fresh empanelment of Hospitals/ Nursing Homes and Diagnostics Centres for ECHS

A number of private hospitals empanelled under the Central Government Health Scheme (CGHS) are considering a move to stop providing cashless services to beneficiaries of the healthcare programme, citing frustration with delays in payment of dues from the government.

An association of hospitals plans to hold meetings next week across four cities to thrash out a consensus, going forward, on their participation in the scheme, even as one Delhi-based hospital has decided to entirely end its association with the scheme.

The Health Ministry, at the same time, is learnt to have sent a request for additional funds of over Rs 1,000 crore for CGHS in the next Budget. A majority of these funds are expected to be used “towards payment of hospital bills and procurement of medicines”, senior Health Ministry officials close to the development told The Indian Express. Delhi-based Pushpawati Singhania Hospital and Research Institute (PSRI) said it will no longer be on the CGHS panel starting October 26.

The scheme promises comprehensive medical care to nearly 35 lakh central government employees and pensioners. Pensioners, ex- and sitting Members of Parliament, freedom fighters and employees serving at CGHS, Directorate General of Health Services and the Health Ministry are entitled to cashless services at empanelled providers.

Pensioners and their dependents account for around 11 lakh of registered beneficiaries, said government sources. It is not clear how many beneficiaries fall under the other categories eligible for cashless services. The government might be mulling a revamp of the scheme and has reportedly sought suggestions from beneficiaries and stakeholders on this until November 30.

Private hospitals currently servicing patients under the scheme argue that operations are becoming unsustainable.

“CGHS has been defaulting on payments to us, and they have not revised the rates, so hospitals will be meeting next week (October 29) … in Bangalore, Hyderabad, Pune and Ahmedabad. They will take a decision on whether they want to continue with the scheme, whether they want to withdraw from it completely or if they want to only stop providing cashless services under the scheme,” said Girdhar Gyani, director general, Association of Healthcare Providers (India).

“The main issue is the government has entered into agreements with hospitals which it has not followed, and this surmounting of arrears puts hospitals in a financial unviability. In the process, the people who are beneficiaries are treated by hospitals as second or third grade citizens, because they don’t like them to come as payments for treating them do not come on time,” he added. AHPI represents hundreds of private hospitals across India, including Apollo, which withdrew its participation in the scheme in Delhi several years ago, as well as Max and Fortis, which still have hospitals empanelled under CGHS.

It is unclear whether hospitals in Delhi, which has the most beneficiaries, will also be holding a similar meeting, but some have said unpaid dues are making it difficult to treat CGHS patients.

“We told CGHS that we are unable to service the requirements of patients … because there are huge payments outstanding. ECHS is still better (in terms of payment) this year, but unpaid CGHS dues have been growing,” Max Healthcare chairman Abhay Soi told The Indian Express.

Senior Health Ministry officials told The Indian Express on condition of anonymity that the ministry has not received such representations from the group, but that payments of dues to empanelled providers have already been stepped up. There are also no plans to revise the 2014 CGHS rates, as they are already “reasonable,” they said.

“There is a gap between the submission of bills and the release of payments and, sometimes, this gap increases. But it is not like the dues are going unpaid,” said one of the officials, adding that around Rs 1,400 crore was released towards payment of dues at the beginning of this financial year.

“We have increased manpower so that bills are paid at a higher rate,” said another official, adding, “If CGHS system rates are so poor, why is there such a huge demand (from healthcare providers) to get empanelled?”

AHPI in July sent a letter to Finance Minister Nirmala Sitharaman saying reimbursements to hospitals was a major concern, as none of the payments for the services offered under CGHS had been made to them within the time stipulated in their agreement.

Queries sent to the finance ministry about the pending dues under CGHS remained unanswered by press time Saturday.

According to Gyani, AHPI members are yet to recover a total of over Rs 400 crore from the government for cashless services provided to CGHS beneficiaries.

A 2017 Parliamentary Standing Committee on Health and Family Welfare report on demands for grants observed that funds allocated to the government under CGHS were under-utilised and that several hospitals had de-empanelled themselves mainly due to non-settlement of dues. “The Committee is of the view that the de-empanelment of some very good CGHS approved hospitals is a major cause of concern and inconvenience to the CGHS patients.”

The government has allocated Rs 1,350 crore for CGHS in the Union Budget for 2019-20, Rs 30.45 crore higher from Rs 1,319.55 crore allocated in 2018-19. In 2017-18, the government’s allocation for the CGHS scheme had stood at Rs 1,182.43 crore.

Source: indianexpress