Haryana IMA threatens to stop treatment for Ayushman Bharat beneficiaries due to delayed payments; State Health Agency responds

In the wake of the Haryana Indian Medical Association (IMA) deadline to stop treatment of Ayushman Bharat scheme beneficiaries in the State over outstanding dues running into several crores approaching in two days, the State Health Agency (SHA) on Tuesday said it has received the budget from the government and the payments to empanelled hospitals was initiated on a ‘First-In-First-Out’ basis.

Haryana IMA president Mahaveer Jain, however, said there was no official communication from the government, and the private hospitals have decided to withdraw the services, adding that several other issues also remained unaddressed.

Around 700 private hospitals are empanelled under the scheme in the State.

In a letter to the Chief Executive Officer of Ayushman Bharat (Haryana Health Protection Authority) on July 28, the Haryana IMA had brought up the issue of delay in payments, and the alleged inaction of the State government despite the matter having been raised several times and repeated assurances.

“Time and again we have been apprising officials of irregular payments, at times delayed by 4-5 months. In our meeting with Chief Minister Nayab Saini on January 8, we were assured that all payments will be made in stipulated time of 15 days. We again had a high-level meeting with Chief Principal Secretary Rajesh Khullar on February 3. We were assured that all problems are being solved now and after March 10 all things will be fully streamlined. Unfortunately, none of these assurances has been fulfilled,” said the letter. It added that the payments were still delayed and irregular, unnecessary deductions were being made and the processing of cases was also delayed.

Mr. Jain told The Hindu over phone that, besides the outstanding dues, several other issues remained unresolved such as heavy deductions in the bills raised by the private hospitals, pending payment of old bills and high-handedness of the government officials. “With the government increasing the BPL limit and extending the scheme to those above 70 years, almost 60-70% population of the State is now covered under the Ayushman Bharat scheme. There are around 1.8 crore beneficiaries. While the annual bill raised by the private hospitals is around ₹2,000 crore, the government allocated only ₹700 crore this financial year,” he said.

Former Haryana IMA president Ajay Mahajan said the payments have been erratic for the past two years and dues were cleared only after the private hospitals ‘threatened’ to stop the treatment under the scheme. “The government must allocate separate budget for the scheme to ensure that it is run smoothly,” he added.

In a press statement, the SHA said the State Health and Family Welfare Department had settled and paid the claims submitted by the empanelled hospitals till the first week of May. A total of ₹2,900 crore was disbursed to the hospitals since the inception of the scheme. During the current financial year, an amount of ₹240.63 crore has been received from the State and Central governments till July 16.

Claims submitted by empanelled hospitals are processed by a team of 50 doctors through the NHA’s online platform. The portal ensures a transparent and impartial claim allocation process by randomly assigning cases to processors. All deductions are made strictly as per NHA guidelines and only when adequate clinical justification or documentation is lacking. The SHA has also taken cognizance of the grievances raised by the hospitals regarding payment delays, claim rejections, and non-processing of claims.