Lok Sabha Question No. 3443 (UNSTARRED), answered on 2022-08-05
Subject: Outstanding Dues of CGHS Empanelled Hospitals
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Hibi Eden, Margani Bharat, Kumbakudi Sudhakaran, Asaduddin Owaisi

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OF HEALTH AND FAMILY WELFARE

## LOK SABHA UNSTARRED QUESTION NO.  3443 TO BE ANSWERED ON 5 TH  AUGUST, 2022

## OUTSTANDING DUES OF CGHS EMPANELLED HOSPITALS

## 3443. SHRI HIBI EDEN:

SHRI MARGANI BHARAT:

SHRI KUMBAKUDI SUDHAKARAN:

SHRI ASADUDDIN OWAISI:

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state: -

- (a)  whether  the  Government  has  reviewed  the  issue  of  outstanding  CGHS  dues  of  empanelled  hospitals amounting to crores of rupees and if so, the details thereof along with necessary steps taken in this regard;
- (b) whether the Government is aware that as a result, private empanelled hospitals are refusing to provide cashless  treatment  to  CGHS  beneficiaries  and  if  so,  the  State/UT-wise  details  of  such  incidents  reported thereof along with the steps taken during each of the last three years and the current year;
- (c) the quantum of dues of private empanelled hospitals pending with the Government, State/UT-wise and hospital-wise;
- (d) the time likely to be taken in clearing the dues of empanelled hospitals;
- (e) the steps taken to ensure the continuation of cashless treatment timely admissions and better facilities to the CGHS beneficiaries in private empanelled hospitals;
- (f) whether the Government proposes to increase the number of claim clearance officers to clear the pending dues and if so, the details thereof; and
- (g) the steps taken to increase the number of empanelled hospitals under CGHS, State/UT-wise?

## ANSWER

## THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (DR. BHARATI PRAVIN PAWAR)

(a)  to  (g):  Under  the  Central  Government Health Scheme (CGHS), serving central government employees avail in-patient treatment at CGHS empaneled Health Care Organizations (HCOs) by making payments and claiming reimbursement thereof from their respective offices. Cashless facility under the Scheme is provided by empaneled private HCOs to pensioner beneficiaries and certain other categories of beneficiaries as per the Memorandum of Agreement (MoA) signed between the HCOs and CGHS. There are no reports on record of denial of cashless treatment to bona fide beneficiaries by empanelled HCOs on account of delay in settlement of bills during last three years. During current year, Max group of hospitals in Delhi/ NCR, Max hospital in Dehradun, Max hospital, Mohali and Fortis hospital, Mohali, Bilroth hospital, Parvathi hospital and Life line hospital in Chennai have reported to stop giving cashless facilities. Show Cause Notices are issued as per terms and conditions of MoA.

Settlement of HCO bills is a dynamic process. There is some time lag between submission of bills by HCOs and  their  final  settlement  leading  to  some  pendency  of  bills.  Hospital-wise  details  of  as  on  date  dues  of private empanelled hospitals are available at the following URL: https://pmjay.gov.in/sites/default/files/202208/Hospital%20wise%20claim%20status%20under%20Central%20Government%20Health%20Scheme.pdf

Following steps are taken for expeditious settlement of bills: -

-  Bill processing is shifted to IT Platform of National Health Authority (NHA) since June, 2021 and software issues are ironed-out by NHA.
-  Additional  Manpower  is  mobilized  by  CGHS  for  scrutiny  and  clearance  of  bills.  Number  of Claim Clearance Medical Officers under CGHS is enhanced to fifty (50).
-  Monitoring is done at senior levels.
-  Bills are processed on Saturdays and Sundays also.

Empanelment  of  hospitals  under  CGHS  is  voluntary  on  the  part  of  intending  private  hospitals.  Private hospitals apply for empanelment under the scheme and get empanelled subject to fulfilment of laid down criteria.

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