The Suvarna Arogya Suraksha Trust (SAST), which runs the State’s health insurance schemes, has recovered a whopping ₹1,26,36,833 from hospitals that charged excess from government-referred COVID-19 patients during all the three waves. The amount has been refunded to 307 patients and their families so far.
When the pandemic hit the State in March, 2020, the Health Department roped in private hospitals and fixed the tariff for private walk-in patients, realising that government hospitals cannot handle the rush of infected patients. It also made private hospitals allot a certain percentage of their beds for government-referred COVID-19 patients.
While treatment for the government-referred patients was free of cost under the State’s Ayushman Bharat Arogya Karnataka (AB-ArK) scheme (with reimbursement from the government), the hospitals were supposed to charge according to the fixed tariff for private walk-in patients.
However, in several cases walk-in patients were charged in excess (over and above the fixed tariff) and many government-referred patients were billed while reimbursement was also claimed from the government.
A total of 2,39,736 patients were treated free of cost under AB-ArK scheme during the three waves.
Over 2,000 complaints
The SAST received complaints from 2,701 patients about such malpractices. On verification by the SAST, it was found a total of 316 hospitals (272 private and 44 government) were involved in instances of excess billing.
While 921 cases were referred to district grievance redressal committees and 138 to the BBMP for further action, the SAST conducted a hearing for 731 cases involving 100 private hospitals, according to data from SAST.
State Health Commissioner Randeep D., who is also the Executive Director of SAST, said the process of hearing 685 cases is under way. “We have recovered over ₹1.26 crore from 78 hospitals so far and have refunded it to the accounts of 307 patients. While ₹13.31 lakh has been recovered through hearings, ₹1.13 crore has been recovered through notices issued to the hospitals,” the Commissioner told The Hindu on Friday.
Explaining that all bills of government-referred patients are cross-checked by SAST’s call centre, he said SAST staff quizzed the patients thoroughly on date of admission, date of discharge, and the expenses incurred.
“Our staff found that there have been cases where hospitals have collected lakhs of rupees from patients and then also claimed the bill from the government,” he said.
He said notices were issued to such erring hospitals and they were made to reimburse the patient. “If they did not do it, SAST withheld further AB-ArK payments to the hospitals and refunded the patient directly,” the commissioner said.
Only some wrongdoers
H.M. Prasanna, president of Private Hospitals and Nursing Homes’ Association (PHANA), said only a handful of the over 6,000 private hospitals in the State may have charged excess for medicine and diagnostic tests from patients.
“This could be mainly due to ignorance and some could have been out of greed. There was a lot of confusion on the treatment packages as to what was included and what was not during the first wave. We clarified from the government and issued an advisory from PHANA to our member hospitals in the beginning of the second wave giving clarity on the treatment packages,” he said.
“PHANA does not stand with hospitals that violate government norms. We had advised our member hospitals to stick to price caps when billing COVID-19 patients,” he added.
People can still complain if they have been charged in excess with original bills for verification on 1800-425-2646; 1800-425-8660 or mail on cvosast@gmail.com
Published - July 02, 2022 01:19 am IST
