Lucknow: The State Agency for Comprehensive Health Insurance Scheme (SACHIS) has initiated action against 16 hospitals empanelled under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana in Bijnor for violating treatment protocols and quality standards.The action came after a three-member inspection team conducted unannounced visits to 20 empanelled hospitals in the district to assess compliance with the scheme’s operational guidelines, Standard Treatment Guidelines (STGs) and prescribed quality norms.
Following the inspections, six hospitals have been issued suspension notices and their payments withheld, while 10 others have been served notices seeking explanations for the irregularities detected during the exercise.
“The inspections were aimed at evaluating whether patient care, treatment procedures, medical records, claim processing and other operational aspects of the hospitals were in accordance with the prescribed standards,” said SACHIS CEO Archana Verma.“The inspections revealed several instances of non-compliance with the scheme guidelines. Among the irregularities flagged were repeated admissions of members from the same family and booking of intensive care unit (ICU) beds without medical necessity, besides deviations from the Standard Treatment Guidelines and quality norms,” she added.
She further said financial penalties would be imposed in accordance with the scheme’s provisions, with the penalty proposed at 10 times the applicable amount wherever violations are established. Notices have also been issued to the audit agency associated with the inspections, while the district programme coordinator has been served a show-cause notice.
Verma said compliance with the scheme guidelines and quality standards was mandatory for all empanelled hospitals and warned that negligence in providing healthcare to beneficiaries would invite strict action. She added that surprise inspections would continue across the state to monitor adherence to the Ayushman Bharat scheme and ensure timely, quality treatment for eligible patients.
