Haryana govt likely to sanction Rs 230 crore to part pay PMJAY dues

Haryana IMA calls it inadequate as unpaid dues since October amount to Rs 400 cr

The Haryana government is expected to sanction around Rs 230 crore to partially pay pending reimbursement dues to hospitals empanelled under the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), according to people privy to the development.

 

This comes after the Haryana unit of the Indian Medical Association (IMA) called for the suspension of services under the AB-PMJAY from February 3, citing the government’s failure to clear pending reimbursement payments since last year.

 

“It is expected that the state government could sanction around Rs 230 crore in the coming days for payment of dues under Ayushman Bharat,” said Suresh Kumar Arora, former president, IMA, Faridabad.

 

The association has called the proposed allocation inadequate as unpaid dues since October 2024 amount to Rs 400 crore.

 

“We are not sure how this would help as the expected allocation is less than outstanding dues,” Dhirendra K Soni, honorary secretary, Haryana IMA, told Business Standard. He added that the Haryana IMA team was in Delhi to discuss the issue with the National Health Authority (NHA) on Tuesday.

 

The AB-PMJAY scheme, which provides a health insurance cover of Rs 5 lakh per family, currently enlists 1,300 hospitals in Haryana, of which around 600 are private sector institutions. The body has also urged the government to pay 1 per cent interest for any delay lasting more than 30 days.

 

“This is part of the contract signed by hospitals while empaneling themselves under the PM-JAY scheme, but no hospital has received such payment from the government despite the heavy pendency of claims,” Soni added. 

 

The Haryana state health agency, which is responsible for implementing the scheme in the state, did not respond to queries till the time of going to press.

 

Calling delays in reimbursement payments a recurring problem, Arora said the Haryana government had failed to find a permanent solution to unpaid dues, leading to cash shortages in hospitals. The Haryana state body also raised the delayed payments issue in March last year, calling for the suspension of treatment under the scheme until the state government gave an assurance to expedite the process.

 

“Other issues which the hospitals are facing include indiscriminate rejection of claims, heavy deductions in payments, and portal issues,” he added. 

 

Soni said the hospitals had only received 10 to 15 per cent of their claimed payments in many cases, with the rest being deducted without giving any reasons.

 

“While scrutinisation of claims is important, such delays can erode at least 15 to 16 per cent of a hospital’s profit margins,” said an administrator for one of the PMJAY-empanelled Gurugram-based hospitals.

 

Another issue raised by the hospitals is the introduction of the Chirayu scheme, a state health insurance scheme that runs parallel with the Centre’s Ayushman Bharat scheme.

 

“While hospitals have been enthusiastically participating in Ayushman Bharat since its launch in 2022, the launch of Chirayu cards in November 2022 have made payments very erratic, due to the sheer number of beneficiaries,” the Haryana IMA stated in an open letter to the Haryana government.