CHANDIGARH: The claims of the AAP-led Punjab government that it is providing the best healthcare facilities in the state seems to fall flat as private hospitals and nursing homes have refused to provide cashless treatment to patients under the Ayushman Bharat Mukh Mantri Sehat Bima Yojna across the empanelled private hospitals in the state.
These hospitals claim that the state government is yet to clear an outstanding payment of Rs 600 crore for various treatments availed of under the scheme. The government says the total pending amount for both public and private hospitals is Rs 364 crore.
As per an MoU between the state health agency (SHA) and the empanelled hospitals, the payment for each case must be completed within 15 days once the patient is discharged. This decision is supposed benefit 42 lakh beneficiaries, of which 13 lakh have been registered under the below poverty line category in Punjab.
Dr Vikas Chabra, president of the Private Hospitals and Nursing Homes Association, said initially only 13 lakh families falling below lakh poverty line (BPL) were entitled to the benefits. But the then state government in 2022 before assembly polls extended the scheme to 29 lakh above poverty line (APL) card holders too.
“The claim settlement, including uploading documents on the State Health Agency (SHA) software is completed by us on the day a patient is discharged. The SHA then has 15 days to process the claim, dismiss or accept it and disburse the amount to the hospital. We incur 1% interest for every payment that remains pending after 15 days,’’ he said.
Chabra said, “We have been providing services in good faith, but no payments have been made for months. The financial burden has become unsustainable.”
Despite repeated assurances of payment clearance within two weeks, no action has been taken, he said. “With no resolution in sight and hospitals facing punitive action for refusing treatment, we announce suspension of all cashless services under the Ayushman Bharat Scheme,’’ said Chabra.
Refuting the claims made by the Private Hospitals and Nursing Home Association Punjab Health and Family Welfare Minister Dr Balbir Singh termed the statement as “false and misleading,” revealing that the total pending amount for both public and private hospitals is `364 crore.
As per official data, the breakdown of pending payments shows that Rs 166.67 crore are owed to public hospitals, while private hospitals are due `197 crore. Balbir Singh said that since April 1 this year the government has disbursed Rs 101.66 crore to private hospitals and Rs 112 crore to public hospitals, totalling Rs 214.30 crore.
He explained that technical glitches arose from February this year after switching to new software for claim processing launched by National Health Agency (NHA), which resulted in slowing down the claim processing. However, the State Health Agency (SHA) took prompt measures, including deputing more staff and working on weekends and holidays, to address the issue.
Singh called a meeting with PHANA representatives on Friday. A meeting with the IMA has also been fixed on September 25 to address concerns about payments and SHS.