Par panel for strict action against CGHS-empanelled hospitals denying admission

New Delhi: A parliamentary panel has asked the health ministry to initiate prompt penal action against hospitals empanelled with the CGHS for denying admission to beneficiaries for in-patient treatment on cashless basis.

The Parliamentary Standing Committee on Petitions headed by Rajya Sabha MP Sujeet Kumar, in its 162nd report, on the petition "praying for comprehensive medical facilities to Central Government employees, pensioners and their dependants” presented to the Rajya Sabha on Thursday said one of the most pressing issues that appear to be affecting a large number of beneficiaries, especially pensioners, is the denial of empanelled private hospitals to admit CGHS beneficiaries for in-patient treatment on cashless basis.

The Committee has been informed of multiple instances where a beneficiary has been denied a bed on account of its purported non-availability.

"However, on deposition of cash, a bed becomes available out of the blue," the panel said.

It said it has also been informed by stakeholders that many empanelled hospitals/medical facilities are not adhering to the 2014 CGHS rates and are charging an excess amount from the beneficiaries.

The Committee has also noted with disappointment that despite the aggrieved beneficiaries bringing the matter to the CGHS (Central Government Health Scheme) concerned, no remedial action has been taken and the empanelled private hospitals continue to indulge in such malpractices.

The Committee impressed upon the ministry to deal with such grievances in a deterrent fashion and initiate prompt penal action against the erring hospital in the event of any irregularity being observed.

The panel also took note of the fact that the empanelled private hospitals often deny OPD treatment/admission on CGHS rates citing that they have huge unsettled bills with the government and that the CGHS rates for a particular procedure are not justified.

"The Committee is of the firm view that the beneficiaries of CGHS must not be the sufferer for any undue delay on part of the government with respect to settlement of bills or illogical rates for a procedure. Besides, empanelled hospitals are under financial distress because of huge outstanding dues from CGHS," the report said.

Therefore, the Committee recommended that the rates prescribed under CGHS for different procedures be reviewed periodically and the government should also devise a mechanism for fixing a time limit for settlement and payment of bills to the hospitals at the earliest.

The panel has been informed that some of the private empanelled hospitals/diagnostics centers are exploiting the CGHS beneficiaries by charging exorbitantly and collecting more fees/charges than what is prescribed by the government under the Memorandum of Agreement signed by them, and thus flouting the terms and conditions of empanelment.

Taking a serious note of such malpractices, the parliamentary panel recommended that the Ministry must deal with any willful violation or non-compliance in a deterrent fashion and ensure surprise inspections of empanelled hospitals for sustained compliance of the terms and conditions of empanelment.

The report highlighted that during its course of deliberations, the panel has worriedly learnt that the CGHS wellness centres (WCs) are suffering from a poor doctor-to-beneficiary ratio. Also the lack of specialist doctors at the WCs is also a glaring fact.

The Committee observes that the shortage of doctors leads to a decrease in quality of patient care and is one of the main reasons for poor patient perception.

The panel,  therefore, recommended that going forward, filling the posts of doctors lying vacant in CGHS WCs must be the foremost priority for the government and the government must also ensure that adequate doctor-to-patient ratio is maintained in all CGHS WCs.