Denying cashless /credit facilities to eligible CGHS beneficiaries – Action taken against Fortis Escort Hospital

The Department of Central Government Helath Scheme has issued an order regarding suspension of empanelled hospital due to denying cashless/credit facility to eligible CGHS beneficiaries…

No.CGHS/JPR/12-58/2014(Admn.)

Dated: 14/03/2014

CGHS has empanelled private hospitals and diagnostic centres in various CGHS covered cities to provide health care facilities to CGHS beneficiaries.

Empanelment of the private hospitals is done under a contractual agreement between the Government of India and the private hospitals and diagnostic centres on mutually agreed terms and conditions.

It was reported that your hospital has taken a unilateral decision of denying cashless/credit facilities to eligible CGHS beneficiaries, which is tantamount to violation of terms and conditions of MOA. Provision of treatment to pensioners and other eligible CGHS beneficiaries is one of the terms of essence, as denial of credit facility causes immense hardship to pensioners beneficiaries, who have to spend money from their meagre savings.

In this connection a Show Cause Notice was issued vide this office letter No.No.CGHS/JPR/12-58/2014(Admn.)/23567-68 dated 10.3.2014 giving an opportunity to your hospital to put forth your stand on the Issue.

The reply dated 12.3.2014 submitted by you in response to the Show Cause Notice has been examined. CGHS signed MOA with individual hospitals and not with any association and hence association has no locus stand in the matter. Hence, the reference is not relevant, Even if any hospital has some grievance and consider not viable for it to continue on the panel, it can withdraw from the list of empanelled hospitals, Government has taken several steps to clear the pending bills on priority basis and therefore, there is no major issue regarding pendency of hospital bills. It is felt that denying the treatment on cashless basis is a gross violation of terms and conditions of the MOA signed by your hospital for empanelment with CGHS.

Since, it is open for your hospital to withdraw from the panel and since denial of cashless facility to eligible beneficiaries is not acceptable from any hospital on the penal, it has been considered appropriate to suspend the CGHS empanelment of your hospital with immediate effect for a period of six months or till further orders, whichever may be earlier. The hospital shall no longer be a part of the list of CGHS empanelled hospitals / Diagnostic Centres for any purpose under CGHS. Patients already admitted prior to issue of this order shall however, be provided treatment at CGHS rates.

sd/-

(DR.D.K.GUPTA)

ADDITIONAL DIRECTOR,

C.G.H.S., JAIPUR.

 To,

The Medical Superintendent,

Fortis Escort Hospital,

J.LN. Marg, Malviya Nagar, Jaipur — 302017

Copy to The Addl.Dy.Director General.(HQ), Directorate General of CGHS, Nirman Bhawan, New Delhi.

Officer I/c, CGHS WC No.1, 2, 3, 4 5, 6, 7 and Polyclinic, Jalpur.

All the Central Govt. Office situated at Jaipur.

UTI/TSL, Bangalore.

Source: http://msotransparent.nic.in/writereaddata/cghsdata/mainlinkfile/File679.pdf