Nagpur: The state government has dropped five city hospitals from the panel of Mahatma Jyotiba Phule Jan Arogya Yojna (MJPJAY) for allegedly collecting money for procedures performed from both patients and the government.
Hospitals are expected to provide all diagnostic and treatment procedures free of cost to the patients. The charges are reimbursed by government. The de-empanelment was done as a part of statewide exercise. Five hospitals are Shatayu Hospital on Wardha Road, Meditrina Hospital in Ramdaspeth, Shri Krishna Hrudayalaya and Critical Care Centre (SKH) in Dhantoli, Crescent Hospital and Heart Care Centre Dhantoli and Keshav Hospital near Manewada.
The hospitals, however, claim the insurance company, MD India Health Insurance TPA Pvt Ltd, running the scheme for government has not done justice to them. They claimed the action was based on complaints of some patients and there was no hearing or explanation taken from the hospitals. One hospital claimed the action was completely biased and in retaliation to its action against company’s employee. All of them deny the charge that they engaged in any illegal financial transactions.
CEO of State Health Assurance Society Dr Sudhakar Shinde told TOI that the process was transparent. “Some of these hospitals were brought under scanner by complaints of patients through the district collector while other complaints came to the insurance company. We gave repeated opportunities to all of them to explain their side but when we got no satisfactory answer, we took the action,” he said.
Dr Shinde said the hospitals were playing mischief. The system has a very robust grievance redressal system. He hinted at stern action against anyone indulging in any unfair dealings.
Dr Sameer Paltewar, director Meditrina, told TOI that the action against the hospital was vengeful action. “We got one arogya mitra, Sheetal Gaikwad, of Paramount TPA caught red handed through ACB taking money from a patient. All complaints against hospital are fabricated. We are demanding an enquiry,” he said.
Dr Aziz Khan, director Crescent, said there were just two complaints which were not resolved. One of the patients had produced a false ration card. “There is no scope for medical management of patient during a heart attack etc in scheme. If we charge these patients for this, the company drags us unnecessarily into the scheme,” he said.
Dr Mahesh Fulwani, director SKH, said the hospital was at fault for taking angiography money from patients. “These patients didn’t tell they would undergo further procedure with us. We have refunded the money of all patients. Arogya mitra in hospital ensures no money is taken and takes it in writing from patient and yet we are being implicated,” he said.
Dr Mukesh Mishra of Shatayu said the hospital had an orthopaedic surgeon who would bring patients to them under the scheme. He would only upload documents and reports for verification. He put the same X-ray report for more than one patient. Hence we got the notice. We have terminated his services,” he said.