Nagaland government says 12 hospitals faced action over AB-PMJAY and CMHIS irregularities, including notices, reimbursement and de-empanelment
KOHIMA — Twelve hospitals empanelled under the Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) and Chief Minister’s Health Insurance Scheme (CMHIS) have faced action for alleged irregularities, Nagaland government informed the Legislative Assembly on Tuesday.
Health and Family Welfare Minister P Paiwang Konyak said six hospitals empanelled under AB-PMJAY, both within and outside Nagaland, and another six empanelled under CMHIS had been served show-cause notices, directed to reimburse funds and/or de-empanelled following detection of irregularities.
“Any hospital which is not following the norms is being penalised and de-empanelled,” he said.
The minister was responding to questions from MLA Kuzholuzo Nienu, who sought details on instances of unauthorised charges imposed by empanelled hospitals and the action taken by the government.
Nienu also asked whether empanelled hospitals could charge beneficiaries beyond the prescribed package rates and under what circumstances such additional charges were permissible.
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Konyak said AB-PMJAY was governed by prescribed protocols and health packages, with each illness and treatment covered according to specified packages.
He explained that in some cases, hospitals may collect additional payments from patients for services that are not included in the prescribed package. Such payments, he said, are made with the knowledge and consent of the patient.
The minister urged beneficiaries who have doubts or complaints regarding such charges to approach the grievance redressal cell of the National Health Protection Scheme (NHPS). Complaints would be examined and investigated, and hospitals found to have committed irregularities would face action, including reimbursement, he said.
AB-PMJAY provides health coverage of up to INR 5 lakh, the minister said. While government hospitals are required to be empanelled under the scheme, private hospitals can choose whether to join.
There are currently 64 hospitals empanelled under the schemes in Nagaland, he informed.
Konyak said the Centre has extended AB-PMJAY coverage to 2.59 lakh households in Nagaland based on the 2011 Census, while the state has expanded coverage to about 2.88 lakh households.
A total of 6,01,948 people are currently covered under AB-PMJAY, excluding those covered under CMHIS, he added.
The minister further said Aadhaar can be used to apply for an AB-PMJAY card and stressed the need for greater Aadhaar saturation. Even beneficiaries without an AB-PMJAY card can have one generated at hospitals through the scheme’s helpline by producing their Aadhaar card, he said.
He clarified that AB-PMJAY does not generally cover outpatient department (OPD) treatment, except for certain day-care services such as dialysis, minor surgeries and chemotherapy.
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