Gurgaon: Private hospitals empanelled under Pradhan Mantri Jan Arogya Yojana (PM-JAY) across Haryana will face scrutiny of treatment bills and package rates. The exercise aims to check whether beneficiaries are being charged separately for services, medicines and consumables already covered under govt-notified treatment packages.Director general of health services, Haryana, has directed all civil surgeons to verify compliance at these hospitals in their districts and submit reports within 30 days.The directive follows a May 5 judgment of Punjab and Haryana high court in Hukam Singh vs State of Haryana & Others. The high court had directed the state to verify package rates being followed by empanelled hospitals and take corrective measures wherever violations of the applicable policy were found. It also directed that treatment costs be explained to patients or their next of kin in a language familiar to them.The verification will include examination of medical bills of govt beneficiaries, along with package rates and rate lists followed by hospitals. Officials have been asked to check whether hospitals are charging the govt-notified rate for a procedure and whether any component covered under a package is being billed separately under medicines, consumables, hospital services or other heads.The health department has specifically asked civil surgeons to check whether hospitals are “artificially reducing/quoting the package rate” and subsequently recovering the cost of essential components or procedures separately from beneficiaries.According to the department’s order, “The practice of artificially lowering package rates to attract patients initially and thereafter charging separately for essential procedures/components shall not be permitted.”The exercise will also cover cases where beneficiaries opt for a room category or implants beyond their entitlement or the govt-fixed rates. Hospitals will be required to obtain the prescribed undertaking in such cases, and officials will check whether the requirement has been followed.Officials will also have to establish whether any amount charged separately genuinely falls outside the notified package and is permissible under govt instructions. They will check whether beneficiaries are informed, in a language familiar to them, about treatment costs and the components covered under the package.Hospitals will also have to provide written confirmation that they will adhere to the notified package rates and will not separately charge for components included in the package. In case of discrepancies, they can be asked to furnish explanations and complete records. Where overcharging is established, the matter can be taken up for appropriate action, including refund of the excess amount wherever applicable, the order said.The department clarified that the exercise is not a revision of package rates. “The purpose of the exercise is to verify strict adherence by empanelled hospitals to the rates and conditions already notified by the govt,” the order said.Under the Haryana Govt Medical Reimbursement Instructions dated July 14, 2020, a package rate is a lump-sum cost covering specified components of treatment. These include admission charges, consultation fees, investigations, operation and procedural charges, anaesthesia, operation theatre charges, surgeon and anaesthetist fees, surgical disposables, consumables, medicines used during hospitalisation and nursing care.Haryana has notified package rates for around 1,340 treatments, including prescribed rates for implants and other components of treatment.
