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WB to conduct audit for prolonged Swasthya Sathi hospital admissions

The state health department has issued an advisory to district authorities and hospitals across Bengal stating that a medical audit will be conducted if any patient is admitted to a hospital for more than 10 days under Swasthya Sathi, a flagship health insurance scheme of the Mamata Banerjee government.

“In the case of common medical management cases, where the prolonged stay of IPD (in-patient department) patients exceeds 10 days, it must be referred to the Medical Audit team for further review,” reads the advisory dated June 24.

“In the case of any default, penalty/action will be initiated against the ISA (implementation support agency), treating doctor, and concerned hospital,” it added. However, the advisory did not mention the amount of the penalty or the degree of action that would be taken for violating the instruction.

Siddhartha Niyogi, the director of health services, said the department would not spare those who violated the instruction. “All authorities dealing with the Swasthya Sathi Scheme have to follow the guidelines while admitting patients,” said Niyogi.

A senior health official said the move was taken after the department received reports that some patients admitted for a particular surgery in a hospital using their Swasthya Sathi cards had undergone another operation not included in the primary package at the time of admission.

“We suspect some tendency of malpractices by performing more than one surgery in addition to the planned operation. It has generated additional bills for the government,” said the health official. “Keeping a patient admitted for more days means bigger bills.”

The Swasthya Sathi Scheme, launched by Mamata Banerjee on December 16, 2016, is a state-borne health insurance programme with a basic health cover of up to ₹5 lakh per year for each family registered with the scheme.

Currently, over 2.4 crore families are covered under the scheme, and the state has involved over 2,400 hospitals which are required to accept the Swasthya Sathi cards. The state government provides the entire cost of the treatment, without any contribution from the beneficiary.

Chief minister Mamata Banerjee, during her multiple administrative meetings, repeatedly pointed out several issues related to the scheme.

The allegation of misuse of the Swasthya Sathi card is not new, as many people have alleged that someprivate nursing homes and hospitals, particularly in districts, ask for more money for surgery in addition to what the Swasthya Sathi package covers. There are allegations against these hospitals for refusing patient admission if family members do not agree to their conditions. Telegraph India

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