The Central Government Health Scheme (CGHS) has recently taken decisive action against several healthcare organizations (HCOs) in the Delhi/NCR region, following serious allegations of fraudulent activities. On November 11, 2024, the CGHS suspended the empanelment of 19 hospitals and healthcare facilities that were previously part of its network. These healthcare organizations have been accused of engaging in unethical practices, including the submission of fake and forged bills, as well as admitting beneficiaries along with their family members repeatedly and periodically to inflate medical claims.
An official order was issued by the Additional Director of CGHS (Headquarters), Delhi, which highlighted the seriousness of the misconduct discovered. According to the order, the implicated hospitals were found to have raised fraudulent bills, leading to their immediate suspension from the CGHS empanelment list. The order referenced earlier communications, specifically Office Memorandum No. S-11045/36/2012-CGHS (HEC), dated October 1, 2014, and OM No. S-11011/09/2022/CGHS (HEC), dated September 13, 2022, under which these healthcare organizations were initially empanelled.
The hospitals that have been removed from the CGHS network include Sharma Medicare Pvt Ltd., Shivalik Medical Centre Pvt Ltd., Apex City Hospital, Jeevan Jyoti Hospital, Bhardwaj Hospital, Surbhi Hospital, Dipakshi Nursing & Maternity Home Pvt. Ltd., Dr. Chaudhary’s Moral Hospital Pvt. Ltd., Prakash Hospital, Kashvi Multi Speciality Centre, Makkar Multi Speciality Hospital, Santosh Multi Speciality Hospital, Navin Hospital, Kosmos Super Speciality Hospital, Prayag Hospital & Research Centre, Pawan Hospital, Flores Hospital, Vasunc Hospital, and Atlanta Mediworld Multispeciality Hospital.
The CGHS order noted, “The matter was viewed very seriously by the Competent Authority, and it has been decided to suspend the empanelment of these 19 healthcare organizations with immediate effect until further orders.” The directive underscores the government’s strict stance on ensuring the integrity of healthcare services provided under the CGHS scheme, which caters to the medical needs of central government employees and pensioners.
Despite the suspension, the CGHS has clarified that patients who were already admitted to these hospitals prior to the issuance of the order will continue to receive treatment at the rates agreed upon under the CGHS guidelines. The healthcare facilities are instructed to continue providing care to these patients until their treatment is completed. Furthermore, the billing for these ongoing treatments must be submitted to the National Health Authority or the concerned department, along with adequate justification for review and payment.
The decision to suspend these hospitals is expected to have significant implications for the CGHS beneficiaries in the Delhi/NCR region, as they will now have a reduced list of empanelled hospitals to choose from. However, the authorities have taken this stringent measure to safeguard the financial resources allocated for healthcare and to prevent the misuse of government funds through fraudulent claims.
This action by CGHS comes amid increasing scrutiny of healthcare providers to ensure compliance with ethical billing practices, especially under schemes that are funded by the government. The authorities are focused on maintaining transparency and accountability within the system, thereby reinforcing trust in the healthcare services offered to government employees and pensioners.
The suspension of these healthcare organizations serves as a stern warning to other empanelled hospitals to adhere strictly to the guidelines laid down by CGHS. It also highlights the government’s commitment to curbing malpractices and ensuring that the funds allocated for healthcare are utilized effectively and ethically.
(Input from various sources)
(Rehash/Ankur Deka/MSM)
