The Ministry of Health and Family Welfare has taken note of certain hospitals being involved in fraudulent activities when submitting bills on the National Health Authority (NHA) portal. There have been several complaints that CGHS beneficiaries are being overcharged and being denied treatment in some cases, the health ministry said in an advisory issued to select CGHS-empanelled hospitals.
To address these issues, the ministry has issued guidelines directing healthcare organisations to adhere to strict compliance to instructions.
The guidelines clarified that hospitals must not deny services to any eligible CGHS beneficiaries.
“In cases of patient death or when the patient is in a coma, the signatures of the beneficiaries’ attendants, along with their mobile numbers, must be obtained on the final bills for all indoor and OPD services, including daycare, laboratory services, dialysis, etc,” the ministry said.
Hospitals have also been directed to report about details of non-referral cases, emergency admissions and consultations to respective additional director’s office of CGHS within 24 hours via email.
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Details of direct visits and admissions of beneficiaries aged 70 years and above, including inpatient card details, must also be reported, according to the latest guidelines.
“Cases that are not reported to the Additional Directors (ADs) will not be processed for approval,” the health ministry’s guidelines state.
The latest guidelines also clarified that CGHS-empanelled hospitals need to prominently display the availability of beds in various wards and ICUs for the benefit of visiting patients.
Beneficiaries must be provided their entitled ward category, the ministry said adding that “allocating a lower category is unacceptable”.
With regard to prescription standards, it said that prescriptions must be written in generic names and in capital letters. Also, hospitals must not insist on specific brands.
As far as charges are concerned, all CGHS-empanelled hospitals need to display on their notice boards and in other prominent places these details – CGHS city the hospital is empanelled under, beneficiaries eligible for credit, name and contact of the Nodal Officer, email ID of Additional Director CGHS.
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