Court Rules Empanelment Under Ayushman Bharat Scheme is a Privilege, Not a Right; Hospital Charged Rs. 9,000 for Blood Meant to be Provided Free to Critically Ill Child
In a significant judgment dated September 28, 2026, the Allahabad High Court (Division Bench comprising Justices J.J. Munir and Indrajeet Shukla) dismissed the writ petition filed by Surgimed Hospital challenging its de-empanelment from the State Health Agency for Comprehensive and Integrated Services (SACHIS), under the Ayushman Bharat-Pradhanmantri Jan Arogya Yojna (AB-PMJAY).
The hospital was removed from the scheme following findings that it charged Rs. 9,000 for two units of blood supplied to a two-month-old infant suffering from blood cancer, despite the scheme's mandate that such essential supplies be provided free of cost to beneficiaries. Additionally, the hospital failed to make mandatory entries regarding blood transfusions in the patient's Bed Head Ticket - a critical document especially for patients admitted to the Intensive Care Unit (ICU). The attending doctor at the hospital admitted these lapses during proceedings before the State Empanelment Committee.
The court emphasized that empanelment under the Ayushman Bharat scheme is not a fundamental or justiciable right but a privilege granted to hospitals that comply with the scheme's protocols and ethical standards. The judgment clarified that such empanelment does not affect the hospital's or doctors' right to practice their profession or treat patients outside the scheme. Rather, it is akin to a patient's choice to opt out of services from a particular healthcare provider due to loss of confidence.
The court noted that the State must confer empanelment in a non-discriminatory manner, but where prima facie evidence shows serious violations - such as charging patients for free services and procedural lapses - de-empanelment is justified. Despite the impugned order lacking eloquence in expression, the facts were undisputed and substantiated by the hospital's own admissions.
Consequently, the court found no grounds to interfere with the de-empanelment decision, thereby dismissing the hospital's petition. The ruling sends a clear message to all empanelled hospitals that strict adherence to scheme guidelines and patient rights are mandatory and violations will attract penal consequences including removal from the scheme.
Bottom Line:
Ayushman Bharat-Pradhanmantri Jan Arogya Yojna - De-empanelment of hospital - Empanelment under scheme is not a justiciable right but a privilege - Where prima facie material showed that hospital charged for blood which ought to have been provided free under scheme and mandatory ICU protocol entries were not made, no interference with de-empanelment order was warranted.
Statutory provision(s):
Ayushman Bharat-Pradhanmantri Jan Arogya Yojna (AB-PMJAY), State Health Agency for Comprehensive and Integrated Services (SACHIS) guidelines
Surgimed Hospital v. Union of India, (All)(DB) : Law Finder Doc Id # 2994077
