The Health Ministry has issued a warning to all private hospitals regarding the overcharging of patients and the refusal to provide services to holders of the Central Government Health Scheme (CGHS) cards. Currently, there are over 1.67 million CGHS cardholders, benefiting more than 4.7 million individuals. Among these, over 940,000 cardholders and 1.94 million beneficiaries belong to the pensioner category.
In addition to central government employees, CGHS cardholders include Members of Parliament, journalists accredited by the Press Information Bureau, and other designated groups. The scheme offers extensive healthcare services and is renowned for its flexible and comprehensive approach to medical care, allowing beneficiaries to receive treatment at approved private hospitals at reduced rates.
Following numerous complaints about excessive charges, refusal of treatments, and fraudulent billing practices, the CGHS headquarters has issued a set of 15 guidelines. These stipulate that prescriptions must be written using generic names in capital letters, and healthcare organizations (HCOs) cannot insist on specific brands. Furthermore, HCOs are required to accept medicines provided by the CGHS, and if they refuse to accept CGHS-restricted medications, they must supply the purchase invoice for those drugs.
HCOs are explicitly instructed not to deny services to any eligible beneficiaries. They must display the availability of beds in various wards and intensive care units clearly for the convenience of patients and must provide beneficiaries with their entitled ward category, as allocating a lower category is deemed unacceptable. If a beneficiary chooses an implant that exceeds the CGHS ceiling price, informed consent must be obtained, explicitly stating that any additional cost cannot be claimed from CGHS, and this consent should be attached to the bill.
The guidelines also mandate the daily uploading of geo-tagged photographs of all admitted patients to the Treatment Management System (TMS) portal. For outpatient cases, pictures taken on the same day must likewise be uploaded. HCOs are prohibited from charging beneficiaries beyond the rates set by CGHS, and they cannot collect or retain hard copies of CGHS cards.
The communication further emphasizes that the submission of falsified bills or fraudulent documents by an HCO will be treated as financial fraud, leading to appropriate legal actions, including filing a First Information Report (FIR) against the institution. Non-compliance with these directives will result in serious penalties, including potential de-empanelment or blacklisting from the scheme.
