Some hospitals empanelled with the ‘Ayushman CAPF’ scheme are under the scanner for alleged wrongful and excessive charging from jawans and their families. These hospitals have been found to be directly charging the personnel, which is illegal, and then raising the bills with the National Health Authority (NHA).
The health insurance scheme, which is a joint initiative of the home ministry and the NHA, is completely cashless and, hence, it is wrong to charge beneficiaries any amount for medical treatment or services.
According to an official, these hospitals are harassing jawans by directly taking money from them citing reasons that the NHA has termed “wrongful”. Now, the authority has asked for a list from all the CAPF with details of such cases as well as a list of hospitals involved, the official added.
“Treatment in empanelled hospitals under the ‘Ayushman CAPF’ scheme is totally cashless, but it has come to the notice that some empanelled hospitals are charging various amounts from patients citing different reasons. This matter has been taken up with the NHA, and it is informed that this is a wrong practice,” stated an official government communication accessed by News18.
“If any empanelled hospital demands any amount, it should be immediately reported to NHA, and further kindly submit details of CAPF personnel who have paid the same for self or dependent(s) treatment to any ‘Ayushman CAPF’ empanelled hospital so that the matter can be taken up,” the official communication stated.
Sources said the government had received complaints from jawans that some empanelled hospitals were raising their bills with the NHA despite charging them or their families directly. A list of hospitals, which have been accused of illegal charging, was being prepared, they added.
Across India, there are over 1,000 hospitals, clinics, and diagnostic centres that are empanelled for hassle-free treatment of close to 35 lakh personnel.
A senior government official said all these hospitals will be served a notice while the bills incurred by beneficiaries directly will be settled. “There have been complaints from jawans that hospitals are taking money from them as well and raising claims with the NHA. In one such case, a jawan was charged for the treatment not mentioned to the NHA, and a claim was later raised with the authority. The hospital took money from the jawan’s family terming it ‘additional charges’, which had not been cleared by the authorities. There have been many more such cases where hospitals in different cities have illegally charged money by putting pressure on the jawan,” said an official, who is aware of the developments in the matter.
The official also said most hospitals under the scanner took some amount of money on different pretexts from jawans or their families at the time of discharge.
The NHA said it had received 2,63,179 claims worth Rs 329.60 crore, of which close to 16,000 are pending and close to one lakh are pending at different levels.
‘Ayushman CAPF’ scheme provides cashless healthcare services to serving CAPF personnel from all seven forces – Assam Rifles, Border Security Force, Central Industrial Security Force, Central Reserve Police Force, Indo-Tibetan Border Police, National Security Guard and Sashastra Seema Bal – and their dependents through Ayushman Bharat PM-JAY IT platform.
Launched on January 23, 2021, in Assam, this scheme will be implemented across the country in a phased manner. The convergence between Ayushman Bharat and CAPF is a first-of-its-kind initiative leveraging strengths of existing IT framework, access to the network of various private hospitals and portability of services across the country.
This initiative will help in moving away from any paper-based manual process of availing healthcare benefits by CAPF personnel and their families to a paperless service at the NHA’s IT platform.
In addition, there is also a 24-hour call centre, online grievance management system, fraud and abuse control system, and real-time monitoring dashboards among other key features of the scheme.
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