Twelve hospitals have been found involved in irregularities related to government health insurance schemes in Nagaland, Health & Family Welfare Minister, Paiwang Konyak informed the State Assembly on Tuesday.
Replying to supplementary questions from Advisor Kuzholuzo Nienu, Paiwang said six hospitals under the Chief Minister’s Health Insurance Scheme (CMHIS) and another six hospitals within and outside Nagaland under the Pradhan Mantri Jan Arogya Yojana (PM-JAY) had been found involved in irregularities.
He said action had been taken against the concerned hospitals, but declined to name them.
Nienu had asked whether empanelled hospitals could charge beneficiaries beyond the prescribed package rates and whether cases of unauthorised charging had been reported.
Paiwang said hospitals cannot arbitrarily charge patients beyond the approved package. However, expenses not included in a particular package may be borne by patients as co-payment, provided the charges are explained and agreed upon.
He said patients who suspect overcharging can approach the grievance redressal cell of the Nagaland Health Protection Society (NHPS). Complaints can be made either verbally or in writing and would be investigated. If irregularities are established, reimbursement could be made and action taken against the hospital.
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Nienu described PM-JAY and CMHIS as popular schemes which had helped needy patients access treatment without undue financial burden. However, he said there was “room for improvement”.
He suggested wider Aadhaar and Ayushman card coverage, greater awareness of the schemes, stronger grievance redressal and anti-fraud mechanisms, and empanelment of more hospitals, especially public hospitals in districts where private healthcare facilities are limited.
He also called for better internet connectivity to facilitate online card generation and implementation of the schemes.
Paiwang said 2,59,468 households in Nagaland had been covered under PM-JAY against 2,88,505 households recorded in the 2011 Census. He said the department was working with district administrations and common service centres to improve Ayushman card coverage.
The minister also clarified that the Ayushman card covers specified hospitalisation and day-care procedures, including dialysis, minor surgery and chemotherapy, while routine outpatient consultations and normal tests are generally outside the scheme’s coverage.
