WB: Regulatory Commission cracks whip on 3 hospitals over allegations of billing irregularities, medical negligence
West Bengal: In a set of directions, the West Bengal Clinical Establishment Regulatory Commission (WBCERC) recently cracked a whip on 3 hospitals in 4 different cases.In one case where a patient was denied cashless admission despite being covered under a health scheme for DVC, the commission ordered the private facility to furnish a fresh bill to the patient following the amount fixed under...
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West Bengal: In a set of directions, the West Bengal Clinical Establishment Regulatory Commission (WBCERC) recently cracked a whip on 3 hospitals in 4 different cases.
In one case where a patient was denied cashless admission despite being covered under a health scheme for DVC, the commission ordered the private facility to furnish a fresh bill to the patient following the amount fixed under the health scheme. The court further instructed the facility that if the whole amount is not covered under the health scheme by DVC on any valid ground, the hospital will have to refund the amount to the patient party.
The commission then also instructed one private facility to initiate a refund and a discount in the bill in two separate cases after the commission received complaints of overcharging on the part of the hospital. The commission has also received allegations of medical negligence against a certain hospital but it has instructed the petitioner to seek redressal from the medical council.
The hospitals which received the instruction from the commission include Ruby General Hospital, Horizon lifeline Multispeciality hospital and Anandalok Hospital.
In the case of Ruby Hospital, the commission considered the case of a 76-year-old man who was under the treatment in the hospital and passed away in December last year. The petitioner claimed that the patient was taken to Ruby hospital for treatment as the hospital had a tie-up with DVC (Damodar Valley Corporation).
The petitioner submitted that the hospital informed them that they had ceased to have an agreement with the DVC for treating its employees and hence the hospital had refused the patient the benefits of the government health scheme. Aggravated by this, the petitioner approached the commission. The hospital claimed that they have already informed DVC that they will not be following a tie-up with it.
However, Retired judge Ashim Banerjee, the commission's chairperson observed, " since the agreement is supposed to continue till February 2021, the patient is entitled to get the benefit."
Hence, the commission instructed the hospital to prepare a separate bill according to the rates of the health scheme of DVC and give it to the patient's family so that they can claim the reimbursement from DVC.
The commission also added in case there is a difference between the amount the patient party has already paid and the amount that will be charged according to the DVC health scheme or any portion of the amount gets rejected on merit by DVC, then the amount should be refunded to the patient party by the hospital.
In another incident, Horizon Hospital was to return Rs 2.5 lakh to a patient's family, who had complained who approached the court alleging overcharging. The patient was suffering from viral pneumonia covid positive and he was also tested COVID positive, He received treatment in the hospital and returned home after being cured in December. The patient complained that he was charged a hefty amount of more than 4 Lakhs for his treatment.
The commission agreeing with the complainant instructed the hospital to initiate a refund of Rs 2.5 lakh.
Another petitioner also sought redressal from the commission stating that the complainant's mother was admitted to the hospital as she was suffering from nephrological problems. She underwent dialysis in the hospital. However, the petitioner alleged medical negligence on part of the hospital stating that the nephrologist was not called for immediately and the dialysis also got delayed due to delay in acquiring the COVID report. The petitioner also alleged overcharging on part of the hospital.
The commission disposed of the case of overcharging after observing that the hospital charged her more than 6 lakhs and the patient has paid almost 5 lakhs. The commission added, Horizon hospital must also offer a discount of Rs 1.34 lakh on the total bill amount to a patient's family.
In the next case, a man who is quite financially unstable sought treatment in Anandalok hospital and underwent treatment there but the doctor attending his advised him to seek treatment in Apollo Hospital and to 3 Lakhs for the purpose. When he expressed his incapability in paying the amount, the doctor allegedly misbehaved with him, alleged the patient. After that, he sought treatment in a Government hospital.
Commenting on the issue, the hospital has confirmed that they have taken action against the doctor. The commission has directed the facility to pay 10000 to the man and has asked the complainant to approach the medical council against the accused doctor.
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