The Hitavada: New Delhi: Monday, May 22, 2017.
TAKING a
serious view of private hospitals “fleecing” patients for cardiac stents, the
CIC has directed the Employees State Insurance Corporation to disclose the
number of patients referred by it to private hospitals for the implants and the
prices paid to those hospitals.
It is alleged
that private hospitals empanelled with the ESIC are overcharging patients by
almost 2.5 times for stent implants and other cardiac procedures. RTI applicant
Pawan Saraswat approached the Central Information Commission (CIC) after he
failed to get a response for his queries on the number of patients referred by
the ESIC to the private hospitals, and the prices paid by the ESIC to those
hospitals for the same.
Saraswat
claimed that while deciding the costs of treatment at private hospitals, the
ESIC goes by the CGHS rates, and when those are not available AIIMS rates are
followed and if both are unavailable ESIC rates are followed. In the rarest
cases which are not listed either in CGHS or AIIMS or in ESI rate list, the
outsourced empanelled “hospital rate minus a discount” is paid, he alleged.
IC Sridhar
Acharyulu said the question is why the ESIC refers thousands or lakhs of
patients to private hospitals knowing fully that they have to shell out 2.5
times the actual price under the CGHS. “The Government/ESIC reimburses the
inflated costs of the implants/devices as and when the empanelled private
hospitals are referred by the ESIC,” he said.
Acharyulu
said “a big business” is being transacted through these references. “The ESIC
should have complained to the health ministry or Union government about
inflation of prices. Instead, it facilitated it for years continuously leading
to unjust enrichment by the private hospitals and stent makers probably with
kickbacks to other key players. Hence there is a huge public interest,” he
noted.
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