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Maharashtra Government De-Empanels 27 Hospitals from Health Insurance Scheme

As many as 27 private hospitals were de-empaneled by the Maharashtra government from its health insurance scheme Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) after officials found manipulation in records, issues of low performance and complaints of charging money from patients. Across the state, three hospitals from Nashik, three from Nagpur, four from Aurangabad, two each from Akola, Pune, Ahmadnagar, and Thane, and one each from Mumbai, Amravati, Sangli, Dhule, Jalgaon, Satara, Solapur, Palghar, and Washim were removed from the list of hospitals serving under the insurance scheme meant for above and below poverty line patients. This is the highest number of hospitals de-empaneled in a single meeting since 2012, when the insurance scheme was launched in Maharashtra. Chief Operating Officer, MPJAY, Dr Sudhakar Shinde, said multiple notices were issued to the hospitals before the de-empanelment was ordered. In May, 20 hospitals were issued suspension orders, of which seven were de-empaneled in the latest meeting. Eight others were given a second chance and six continue to remain on suspension.

In June, the MJPJAY committee took up 20 more hospitals, against whom there were regular complaints, and de-empaneled them. The insurance scheme, that provides coverage of ₹1.5 lakh for 971 procedures, covers 2.25-crore population in the state. Of the 27 private hospitals de-empaneled, 12 faced complaints of low performance and low bed-strength, and three were inactive in implementing the scheme. There were complaints of charging money from patients and manipulation in records in at least six hospitals — Shatayu (Nagpur), Shri Krishna Hrudalaya and Critical Care Center (Nagpur), Vijay Vallabh (Palghar), Deshpande (Ahmadnagar), Parashree (Amravati), and Crescent Hospital and Heart Center (Nagpur). Dr Balasaheb More, medical officer in-charge at Deshpande hospital, Ahmednagar, said the hospital was in the process of resolving the complaints when the de-empanelment notice was issued. The MJPJAY committee stated that nine show cause notices were issued regarding complaints of money collection and inactive specialties, to which the hospital failed to respond. “We responded to two show-cause notices. There were few tests that we had asked patients to undergo from outside but treatment was provided free of cost,” More said.

At Vijay Vallabh hospital in Palghar, Chief Executive Officer Dr Shweta Shukla said, “We asked for a chance to clarify but we never got one. These are false allegations. Some of the state officials were into illegal money collection, which we opposed. We have maintained all records that can be inspected.” In Nagpur, officials at the Shatayu hospital and Research Center claimed a mail on manipulation of records of X-ray reports was received from MJPJAY. Administrator Afghan Siddiqui said, “There is no issue of money collection. We also gave clarification on X-ray records which happened a year ago. Consultants would get X-ray tests from outside because we did not have digital X-rays. We terminated the consultants much before MJPJAY raised red flags.” Currently, the MJPJAY scheme has at least 500 hospitals on the wait list to enroll. Shinde said, “We are de-empaneling non-performing hospitals and encouraging hospitals in Marathwada and Vidarbha regions to empanel. Those are the areas where there are very few hospitals under the scheme.” The state government has also empaneled 32 new hospitals from across Maharashtra, especially from the Vidarbha region, to balance the spread of hospitals in urban and rural regions. Among the 32, there are three government hospitals — sub-district hospitals in Dahanu and Wardha, and a women’s hospital in Osmanabad. – Indian Express