Court Grants Interim Relief to Maatri Medicity and Orthocare Hospital, Directs State to Settle Approved Claims
In a significant ruling, the Himachal Pradesh High Court has granted interim relief to M/s Maatri Medicity and Orthocare Hospital, directing the state to release pending payments for approved claims under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojna (PM-JAY) and Himcare Scheme. The court's decision came in response to petitions filed by the hospital, which argued that despite being empanelled under these government healthcare schemes, their legitimate claims for cashless treatments provided to beneficiaries had not been settled.
The case, presided over by Justice Jyotsna Rewal Dua, highlighted the plight of empanelled healthcare providers who faced financial hardships due to delays in payments by the state. The judgment emphasizes the legal obligation of empanelled hospitals to deliver cashless treatment to beneficiaries under the Ayushman Bharat PM-JAY and Himcare Scheme, which aims to provide universal health coverage as part of the National Health Policy, 2017.
The petitioners, represented by Advocate Mr. Ajay Chandel, presented their case stating that all their claims had been duly approved and even reflected on the official website of the respondents. Despite this, the non-release of payments was causing severe financial strain on the hospital's operations.
The court noted that the Ayushman Bharat scheme is designed to address healthcare needs at various levels, including primary, secondary, and tertiary care, with a commitment to leaving no one behind. The Himcare Scheme, launched by the Government of Himachal Pradesh, further extends similar benefits to families not covered under the central scheme, thereby ensuring broader healthcare access.
In its judgment, the court found no justification for the respondents' failure to release payments for the approved claims and directed that the payments be made promptly. The court has set a deadline for compliance, with the next hearing scheduled for March 25, 2026, by which time a reply is expected from the respondents.
Bottom Line:
Empanelled hospitals under Ayushman Bharat PM-JAY and Himcare Scheme entitled to receive payment for approved claims of cashless treatment provided to beneficiaries.
Statutory provision(s): Ayushman Bharat Pradhan Mantri Jan Arogya Yojna (PM-JAY) Guidelines, National Health Policy, 2017, Mukhya Mantri Himachal Health Care Scheme (Himcare) Guidelines.
