Mumbai hospital ‘fleeces’ patients covered by state insurance scheme

The hospital has been overcharging patients covered under Mahatma Jyotiba Phule Jan Arogya Yojna

A hospital in Byculla has been allegedly overcharging patients covered by a state-funded health insurance scheme, Mahatma Jyotiba Phule Jan Arogya Yojna, said officials from State Health Assurance Society (SHAS). Families with an income of less than ₹1 lakh are eligible for free treatment under the health insurance scheme.

Probe revealed that at least 20 patients were overcharged — anywhere between ₹17,000 to ₹25,000. (HT PHOTO)

Dr Sudhakar Shinde, who heads SHAS, along with other department officials, paid a surprise visit to Balaji Hospital, Byculla, on May 19. The team found major lapses in implementation of the scheme. “We started with Balaji Hospital because it is close to our office,” Shinde said.

After interacting with patients at the hospital, health officials found six patients were overcharged. “We scrutinised their medical records and bills, and found that they were overcharged,” said Shinde.

Probe revealed that at least 20 patients were overcharged — anywhere between ₹17,000 to ₹25,000. “This scheme is for poor patients, who don’t have money. Patients don’t understand medical terminologies and the hospital has taken advantage of their ignorance ,” said another official.

The team also contacted patients who were treated under the scheme earlier and discovered that 14 patients had been overcharged. “We sought their medical records and got them verified from our in-house doctors. THese patients were overcharged as well,” official added.

Most of these patients were seeking treatment for cardiovascular ailments. Shinde said several private hospitals are fleecing patients.

Althought Balaji hospital has been barred from treating patients under SHAS scheme for three months, decision to blacklist the facility will be taken after a meeting between insurance company, SHAS and Third Party Provider (TPA) officials. TPA helps in implementation of the scheme.

“We haven’t violated norms. Patients were charged extra because the procedure is not a part of the package covered under health insurance scheme or the cost of the treatment exceeded ₹1.5 lakh, ” Dr Ramesh Kagzi, medical director, Balaji Hospital. “They haven’t heard our side of the story. Moreover, we are yet to receive a show cause notice. Once we do, proof that we haven’t falsely overcharged will be submitted.”