Himachal HC seeks clearance of pending Ayushman Bharat, Himcare dues

Himachal Pradesh High Court has directed the union and State governments to clear pending dues of empanelled private hospitals under Ayushman Bharat national flagship and Himcare scheme, observing that delay in release of legitimate claims defeats the objective of cashless healthcare for beneficiaries.

The order was passed on Wednesday by a Single Bench of Justice Jyotsana Rewal Dua while hearing the matter titled M/s Maatri Medicity and Orthocare Hospital vs. State of H.P. & Ors., along with connected petitions.

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The petitioner-hospital approached the court alleging that substantial payments towards treatment provided under the two schemes had remained unpaid for a considerable period, causing financial strain and hampering medical services.

In its petition, M/s Maatri Medicity and Orthocare Hospital submitted that it had provided cashless treatment to eligible beneficiaries under Ayushman Bharat and Himcare in accordance with the terms of empanelment.
However, despite raising bills through the prescribed online portal and complying with procedural formalities, the claims were not settled within the stipulated time.
The hospital contended that continued non-payment was adversely affecting its operational viability and its ability to provide uninterrupted services to economically weaker sections.
Taking note of the submissions, the court observed that the very purpose of introducing cashless treatment schemes is to ensure that patients from vulnerable backgrounds are not denied healthcare for want of resources.
If empanelled hospitals are compelled to wait indefinitely for reimbursement, the sustainability of the scheme itself is jeopardised.
The bench directed the respondents, including the union of India, the State of Himachal Pradesh, and the concerned implementing authorities, to examine and process the pending bills of the petitioner hospital strictly in accordance with the scheme guidelines.
The authorities were asked to clear admissible claims in a time-bound manner after completing the necessary verification.

The court further observed that once hospitals are duly empanelled and treatments are provided as per approved packages, payments cannot be withheld arbitrarily.
It emphasised that administrative or procedural bottlenecks couldn’t become a ground to frustrate the implementation of welfare schemes meant for the poor.
The matter has been disposed of with directions to ensure expeditious clearance of dues. The ruling is expected to bring relief not only to the petitioner but also to other empanelled hospitals facing similar delays under centre-run Ayushman Bharat and the state-run Himcare scheme.