Jabalpur, May 19 (ILNS) The Jabalpur Bench of Madhya Pradesh High Court has directed the Director of Central Government Health Scheme (CGHS) to ensure that in future, all the CGHS-empanelled private hospitals do not refuse to provide treatment to bona fide CGHS beneficiaries and adhere to the charges fixed by the state government in that behalf.
The Division Bench of Chief Justice Mohammad Rafiq and Justice Atul Sreedharan passed this order, while disposing a Public Interest Litigation filed by Subhas Chandra, in the capacity of Chairman, Citizen Welfare Association, a registered body for the benefit of members of CGHS scheme.
The allegations in the petition are that even though several hospitals, in particular City Hospitals and Research Centre Pvt Ltd, Metro Hospital and Cancer Research Centre, Swastik Multispecialty Hospital and Research Centre, and Anant Nursing Home Pvt Ltd have been empanelled for the treatment of Central Government employees and the pensioners covered under the said scheme during the ongoing Coronavirus pandemic, are being denied treatment, in as much as the charges fixed by the Central Government, are not being honoured.
The petitioner referred to the order dated May 10, 2020 issued by the Director, CGHS providing that CGHS rates for treatment for COVID-19 in private empanelled hospitals in respect of CGHS beneficiaries in a city shall be as per the package rates prescribed by the concerned state government.
In case no such rates have been prescribed by the state government in any CGHS city, the rates prescribed by the Government of NCT Delhi shall be applicable.
Further reference made to an order dated June 20, 2020 issued by the Principal Secretary, Health and Family Welfare Department, Government of National Capital Territory of Delhi, showing that the Delhi Disaster Management Authority accepted the recommendations of the Committee for fixing the rates for COVID-related treatment, to be charged by private hospitals in NCT of Delhi.
Ajay S Raizada, Counsel for the petitioner, contended that even for very severely sick patients in ICU with ventilator care, the maximum rates prescribed for the treatment is Rs 18,000 per day, which includes the cost of PPE kit, in respect of NABH accredited hospitals and Rs 15,000 per day for non-NABH accredited hospitals.
It was further contended that the local Additional Director, CGHS is hand-in-glove with the private hospital as despite the petitioner making several complaints to him against the private hospitals, he has not taken any action against them, to ensure that the beneficiaries covered under the CGHS scheme get the benefit of the said scheme.
The petitioner has given instances, where the private hospitals arrayed as respondents in the present petition have not only refused to give treatment to CGHS scheme covered patients, but also certain instances of taking exorbitant charges and not providing treatment.
It is submitted that even though the petitioner made complaints, but no action has been taken by the respondent authorities to either ensure that private hospitals empanelled for treatment of beneficiaries covered under the CGHS scheme honours the rate prescribed by the concerned State Government or the rates prescribed by Government of NCT Delhi.
It is also submitted that no action has been taken against the hospitals in respect of which specific complaints have been made.
JK Jain, Assistant Solicitor General, submitted that if the petitioner has any specific grievance, he should approach the Director, CGHS for redressal thereof.
The Court, while considering the rival submission, ordered that the petitioner make a comprehensive representation to the Director, Central Government Health Scheme, Nirman Bhavan, New Delhi, who shall get the complaint of the petitioner enquired into, preferably by deputing an independent officer, for taking appropriate action against hospitals herein after notice to them.
If the allegations against these hospitals are proved, appropriate action including for de-empanelment may be taken.
“The Director, CGHS shall also ensure that in future, all CGHS-empanelled private hospitals do not refuse to provide treatment to bona fide CGHS beneficiaries and adhere to the charges fixed by the State Government in that behalf,” the order read. ILNS/SHV/RJ