High Court stays suspension of healthcare schemes by private
High Court stays suspension of healthcare schemes by private hospitals in Nagaland
Kohima Bench of Gauhati High Court has directed the Nagaland Private Doctors’ Association (NPDA) to continue providing medical services under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) and the Chief Minister Health Insurance Scheme (CMHIS)
DIMAPUR — The
Kohima Bench of Gauhati High Court has directed the Nagaland Private Doctors’ Association
(NPDA) to continue providing medical services under the Ayushman Bharat Pradhan
Mantri Jan Arogya Yojana (AB-PMJAY) and the Chief Minister Health Insurance
Scheme (CMHIS), staying the association’s decision to suspend services from
February 15.
The interim order comes in response to a Public Interest
Litigation (PIL) seeking unhindered implementation of the health insurance
schemes in Nagaland.
The PIL highlighted concerns regarding the implementation of
the AB-PMJAY/CMHIS, which provides cashless health coverage of INR 5 lakh per
family per year for secondary and tertiary care hospitalisation. The AB-PMJAY
scheme, launched in Nagaland in 2018, was merged with the state government’s
CMHIS in 2022 to expand cashless healthcare coverage to government employees,
pensioners, and indigenous residents not covered under AB-PMJAY.
Accordingly, a Memorandum of Understanding (MoU) was signed
between Nagaland Health Protection Society (NHPS) and Future Generali India
Insurance Company Ltd. (FGI) on June 14, 2024, after the insurer was selected
through a national tender process.
However, in January 2025, several empanelled hospitals began
suspending services, citing non-payment of claims by the FGI. This led the NHPS
to issue a statement announcing that “there have been reports of alleged fraud
and abuse/misuse, including financial exploitation of vulnerable patients by
certain empaneled hospitals.”
The NHPS also stated at the time that the department “has
initiated an investigation to examine all such allegations and ascertain the
commitment of any fraud or abuse by hospitals.”
Subsequently, in a statement on February 11, the NPDA, which
represents private hospitals in Nagaland, announced a suspension of PMJAY/CMHIS
services from February 15, citing non-payment of claims by the insurance
company.
Among others, the association claimed that the FGI was in
“violation of the payment terms/agreement, wherein it was stated that all
claims will be cleared after 15 days of claim settlement.”
The NPDA also criticised the NHPS’s statement on fraud
allegations, arguing that penalising all empaneled healthcare providers for the
alleged actions of a few was “unjust.” Stating that the allegations “should
have been addressed internally to avoid unnecessary defamation,” the
association demanded a public apology from the NHPS for what it termed as
“unwarranted allegations.”
During the court proceedings on Friday, the NHPS stated that
it had already informed FGI to clear genuine claims, but the insurance company
has not complied.
The bench comprising justices LS Jamir and Kakheto Sema
subsequently issued an order staying the NPDA’s February 11 decision until the
next hearing, scheduled after four weeks.
“In the interim, the letter dated February 11, 2025, written
by the Respondent No. 6 [NPDA], shall remain stayed, and accordingly, the
Respondent No. 6/Nagaland Private Doctors’ Association is directed to continue
providing all the facilities to the eligible beneficiaries under the
AB-PMJAY/CMHIS in the larger interest of public till the next returnable date,”
the order stated.
Dialysis patients
Meanwhile, a group named the ‘Dialysis Patient’s Union
Nagaland’ has expressed anguish over what it stated was the decision of
hospitals not to acknowledge dialysis treatment under the AB-PMJAY and CMHIS
“due to non-payment of pending bills by insurance company.”
In a press release issued on Friday, the union urged the
government of Nagaland to immediately address the situation. “It is to be noted
that many dialysis patients and others with serious health issues covered under
these health insurance schemes would be drastically affected, putting very
serious strain on their meagre financial resources,” it added.
