PGI Chandigarh flags Rs 143 Crore reimbursement under HIMCARE scheme

Chandigarh: The Postgraduate Institute of Medical Education and Research (PGI), Chandigarh has raised serious concerns regarding the significant delay in reimbursements under the Himcare Health Scheme of the Himachal Pradesh government. According to official sources, PGIMER has submitted 1,478 claims amounting to nearly ₹143 crore, which remain pending with the state government.

This delay is particularly alarming as nearly 40% of PGI’s patient intake is from Himachal Pradesh.

Medical Dialogues had previously reported that the Postgraduate Institute of Medical Education and Research (PGI) here has signed an Mou with HIMCARE, a scheme of the Himachal Pradesh government to provide cashless treatment, an official said on Monday.

Also Read: PGI Chandigarh, HIMCARE join hands for cashless treatment

The issue was formally raised during the Feb 2025 meeting of the PGI governing body (GB), which was chaired by the Union Minister of Health and Family Welfare. The GB noted that, according to the MoU, the Himachal government is obligated to disburse funds for cashless services provided under HIMCARE, within a month, TOI reports.

Under a Memorandum of Understanding (MoU) between PGIMER and the Himachal Pradesh government, these claims are required to be cleared within a month. However, this timeline has reportedly not been met, creating financial pressure on the premier health institution.

As per the recent media reports by the Indian Express, the Governing Body has directed the PGIMER’s administration to take up the matter with the state authorities and ensure time-bound clearance of the dues, as delays could impact the institute’s financial stability and may hinder the delivery of other essential health services.

Compounding the crisis are serious allegations of financial misconduct involving funds from both HIMCARE and the central government's Ayushman Bharat scheme. There are reports that individuals, allegedly in collusion with certain PGI staff members, siphoned off funds meant for underprivileged patients.

In light of these allegations, PGI’s vigilance department has recommended a Central Bureau of Investigation (CBI) probe to investigate possible embezzlement and ensure accountability.

PGIMER, which caters to thousands of patients from Himachal Pradesh annually, implemented a cashless treatment system under the Himcare scheme on March 8, 2024. The system allows eligible patients to receive treatment by simply submitting a photocopy of their Himcare card and hospital slip, removing the earlier requirement of waiting for approvals and reimbursements.

Under Himcare, the Himachal Pradesh government provides cashless treatment up to ₹5 lakh per annum per family, covering a broad spectrum of healthcare services. It is estimated that 4,000 to 5,000 patients from Himachal Pradesh benefit from treatment at PGIMER every year.

Also Read: PGI Chandigarh staffer held in Ayushman fraud case

According to the Indian Express, PGIMER said in a statement that following the directive from the Governing Body, the institute has addressed this matter with the appropriate authorities of Himachal Pradesh.

The institute clarified that the dues are being cleared gradually through periodic grant releases from the Himachal Pradesh Government, describing the process as “routine and ongoing.”