Court Orders State to Clear Pending Hospital Bills with Interest, Ensuring Compliance with Ayushman Bharat and HIMCARE Schemes
In a landmark judgment, the Himachal Pradesh High Court has directed the state government to promptly settle all pending claims of private hospitals under the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojna (AB-PMJAY) and the Mukhya Mantri Himachal Health Care Scheme (HIMCARE). Justice Jyotsna Rewal Dua ruled that the state must clear all duly approved pending bills within three weeks, along with interest for any delays beyond the stipulated timelines.
The court highlighted that financial constraints or ongoing vigilance inquiries cannot justify withholding payments to hospitals that have already provided treatment services. The state is mandated to honor its financial commitments under these healthcare schemes, which are crucial for maintaining the functioning of private hospitals and the overall public health system.
The judgment arose from petitions filed by M/S Maatri Medicity & Orthocare Hospital and other private hospitals, who argued that they were not receiving timely payments for services rendered under the government schemes. The court found that the delay in releasing approved bills was unjustified and ordered the state to pay interest at the rate of 1% per week for delays beyond 15 days, as stipulated in the schemes.
Justice Dua emphasized that the state cannot use financial constraints or pending investigations as excuses to delay payments. The court asserted that the state is obligated to fulfill its financial commitments, as failure to do so affects the sustainability of the healthcare schemes and undermines the public health goals they are intended to achieve.
Moreover, the court instructed that future claims under the AB-PMJAY and HIMCARE schemes must be processed and released promptly, adhering to the timelines set forth in the schemes. The central government was also reminded to ensure the timely release of its contribution under the AB-PMJAY scheme.
The court allowed for the possibility of recovering amounts from the hospitals if future investigations find discrepancies in past claims, but clarified that such inquiries should not delay the payment of verified claims.
This judgment underscores the judiciary's role in ensuring that public welfare schemes are implemented effectively, protecting both the rights of service providers and the health of citizens.
Bottom line:-
Delay in releasing duly approved bills of empanelled hospitals under government healthcare schemes is unjustified and arbitrary. The State is liable to clear all approved claims under Ayushman Bharat-Pradhan Mantri Jan Arogya Yojna (AB-PMJAY) and Mukhya Mantri Himachal Health Care Scheme (HIMCARE) within stipulated timelines, along with interest for delays as per scheme provisions.
Statutory provision(s): Article 300(A) of the Constitution of India, Ayushman Bharat-Pradhan Mantri Jan Arogya Yojna (AB-PMJAY), Mukhya Mantri Himachal Health Care Scheme (HIMCARE).
