Wednesday, June 1, 2011

Irregularities in RSBY bills, DHS notices 5 hospitals




The Directorate Health Services (DHS) has shot notice on five hospitals of the state listed by the state government under Rashtriya Swasthya Bima Yojna (RSBY) for irregularities in billing under the scheme. According to information, the DHS discovered that these hospitals had manipulated the bills of the patients who underwent treatment there under the scheme through smart cards.

The DHS officials informed that the treatment charges in the bills were mentioned much higher than those quoted by the five hospitals during their listing. The Health Director Dr Kamalpreet Singh said that stern action would be taken against all the five hospitals and they would be removed from the list of government recommended hospitals for treatment under RSBY.
The RSBY nodal officer at DHS Dr Madangopal informed that the government had signed pact with Oriental Insurance Company (OIC) for treatment of beneficiaries holding smart cards. The scheme is being carried out in 16 districts of the state. The OIC has constituted inspection team to scrutinise the bills produced by the hospital where the smart cardholders take treatment. The DHS sends at least 20 bills from each district to the OIC inspection for scrutiny on daily basis.
The irregularities in five hospitals unleashed when the inspection team discovered that their bills sent by the DHS from May 14, 2011 onwards were manipulated.
The OIC has revoked its orders to release payment of all the five hospitals which are – Sewa Sadan Mata Rajim Hospital, Raipur Hospital (both from Raipur district), MP Nursing Home (from Durg district), Mission Hospital, Kamleshwar Netralaya (both from Sarguja district) and Dr Lalchandani Hospital (from Bilaspur district)
Notably, the treatment of patients through smart cards in Chhattisgarh started some one and a half years back and in short span of time the state got national award for achieving 100 percent target under RSBY. Ever since, the DHS inspection team has trapped six hospitals for providing manipulated bills to the patients.

The RSBY is a Centrally-sponsored scheme for the Below Poverty Line (BPL) families in the unorganised sector. Formally launched on October 1, 2007, the scheme aims to provide the insurance cover to BPL households from major health shocks that involve hospitalisation.
The state government aims to prepare smart cards for about 24.94 lakh BPL families. By far, it has registered 18.67 lakh BPL families and issued 14.13 lakh smart cards.
Under the scheme, the BPL families are entitled to more than 700 in-patient medical procedures with a cost of up to Rs 30000 every year for a nominal registration fee of Rs 30. The RSBY facilitates coverage of pre-existing medical conditions of the BPL families and there is no age limit for treatment. The insurance coverage extends from the head of household to the spouse along with three dependents.
The state government has empanelled 615 hospitals (government – 412 and private - 203) for free-of-cost treatment of the BPL families holding smart cards. The treatment and hospitalisation expenditure on the beneficiaries is being completely incurred by the insurance company.


The DHS officials informed that the Mission Hospital in Sarguja district had mentioned higher rates of treatment in its rate cards for beneficiaries under RSBY. Earlier some of the patients had complained in this connection, but after the OIC inspection team found the irregularity, the DHS quickly shot notice to this hospital. The officials informed that the Raipur Hospital too had produced fake bills of five treatment cases on May 14, 2011 while the inspection team found that the number of patients admitted on the particular date were less than the claimed ones.

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