‘Swasthya Sathi’ patients: Health dept to conduct audit to check ‘inflated bills’
Kolkata: To stop the alleged tendency of keeping patients empanelled under Swasthya Sathi scheme in hospitals for prolonged periods leading to inflated bills, the Health department has decided to conduct medical audits of all cases of common medical management where staying of IPD (in patient department) cases go beyond ten days.
“We will be conducting medical audits of all cases of common medical management where the staying of IPD (in patient department) cases go beyond ten days. The audit team will review whether such prolonged hospitalisation is indeed required and accordingly release the payment,” a Health department official said. The department has also come across instances of blocking of multiple packages under general surgery and gynaecology such as ‘Adhesiolysis’ in addition to primary planned surgery under Swasthya Sathi.
In this backdrop, the Swasthya Sathi Samiti, under the state Health and Family Welfare, has issued advisories to all concerned that for planned general surgery such as laparoscopic or open cholecystectomy, appendicectomy and in gynaecological procedures like abdominal or vaginal hysterectomy, no additional package can be blocked and all treatments needs to be covered under the existing package.
“In case of any default, we will initiate penalty/ action against ISA, treating doctor and concerned hospital,” the official said, reiterating that the move is aimed at patient safety and proper utilisation of Swasthya Sathi scheme in the state. Swasthya Sathi is basic health cover for secondary and tertiary care up to Rs 5 lakh per annum per family. It is paperless, cashless and smart card based. All pre-existing diseases are covered. There is no cap on the family size and parents of both spouses are included. All dependent physically challenged persons in the family are also covered. The entire cost is borne by the state government. The scheme covers over 2.4 crore families with more than 2400 hospitals empanelled.