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July 29, 2020

Audit to be carried out of COVID bills of over Rs 2 lakhs – Maharashtra Govt

by Mahesh Mara in Compliance Law

Audit to be carried out of COVID bills of over Rs 2 lakhs – Maharashtra Govt

Auditors from the municipal corporations and the district collectorate are soon to be appointed at all Covid-19 hospitals. They will pre-audit the bills given to Covid-19 patients at the time of their discharge to avoid complaints about overcharging.

Steps taken by the Maharashtra Government to curb COVID Treatment costs

  • In May, Maharashtra imposed a price cap on private hospitals treating Covid-19 patients after allegations that many of these healthcare facilities were charging exorbitant fees in a bid to compensate for a 90% dip in the admission of non-Covid-19 patients.
  • Restrictions had also been imposed on the billing of medicines in private hospitals.
  • Private hospitals are allowed to charge up to Rs 4,000 daily for the treatment of Covid-19 patients on a general bed, Rs 7,000 for intensive care unit (ICU) and Rs 9,000 for a ventilator, according to the new guidelines issued by the state health department.
  • All private hospitals come under the Epidemic Diseases Act, 1897, and are liable to follow the rules of the state government amid the pandemic.
  • Government-run hospitals are offering treatment for free, while 1,000 hospitals are covered under the Mahatma Jyotiba Phule Jan Arogya Yojana, which provides insurance coverage of Rs 1.5 lakh.
  • Private hospitals have to provide treatment as per the concessional rate decided by the state government.

What do you mean by Medical Bill Auditing?

Medical bill auditing is important in situations where one has extensive medical treatment, such as that involved with an extended hospital stay. With numerous medical personnel attending to one’s treatment and care, there are bound to be mistakes made in properly recording the medical services provided and the medical supplies used. Auditing medical bills basically involves comparing the record of the treatment to the itemized bill to determine that treatment and supplies were delivered as charged.

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Audit of COVID Bills is being initiated due to overpricing by some Hospitals

Several complaints have come to the fore in the last three months about exorbitant bills that patients have received from hospitals. A FIR had been lodged against Nanavati Super Speciality Hospital (NSSH) in Mumbai by BMC for allegedly overcharging a patient for their coronavirus treatment. The complainant was charged a total bill of Rs 17 lakh by the hospital.

BMC started an inquiry in the matter and detailed audit of bills was conducted. The process was completed with the help of a senior doctor. After the probe, BMC officers found details how hospital escalated the bills. Here are some measures that were used to ramp up the treatment bill:

  • For the treatment of the patient every day, 5 PPE kits were being used. Every PPE kits come with N-95 mask, but three additional N-95 masks price were added in the bill.
  • Tablets like aspirin, B-complex, paracetamol were included in the package when the patient is admitted to the hospital. However, charges for all the above tablets were listed separately in the bill
  • The hospital conducted several other tests on the patient. Some tests were conducted multiple times.
  • Oxygen was given to the patient for over 12 hours a day and extra charges were put in the bill.
  • Several of the tests conducted on the patient were done between 1 am and 3 am. Since this is an emergency period, tests done cost more.

Many such instances like the above arose where patients were being overcharged. For instance, in the month of June it was reported that a teenager got a bill of around Rs 6.5 lakh from Nanavati hospital. She had Covid-19 and was at the hospital for 23 days. Her bill included “care and hygiene” charges of Rs 53,850 and “staff management” charges of Rs 38,000. The woman then took up the issue with MNS leader Sandeep Deshpande, who demanded an audit of the bill.

What will the audit of COVID Bills entail?

Issues were raised on social media and there were registered written complaints against overpricing by hospitals. The district administration took cognizance of the same and is to appoint auditors from various departments to “pre-audit” the bills. The work of the pre-auditor is to:-

  • Check the bills before it reaches the patient. According to the officials, nearly 26 of the 400 bills, where patients were charged over Rs 2 lakh from various hospitals, are under scrutiny. 
  • Auditors from corporations and collectorates who will be appointed at the hospitals will double-check the bills as per the government capping charges. Only then will the patient make the bill payment.
  • Hospitals will be de-empanelled or served notices in case of bill related malpractice. 
  • However, as of now, the Government needs more hospitals to care for Covid-19 patients, so just a warning is being given. 

State health minister Rajesh Tope had backed the appointment of such auditors from the administration so that billing issues can be resolved.  Advocate and activist Yogesh Mehta told that the state government has failed to give wide publicity to various health schemes, the maximum rates which private hospitals can charge, the list of empanelled hospitals where the treatment is free, and what items and services can be charged and what cannot be charged.

 This leads to patients ending up paying more than Rs 10 lakh to Rs 12 lakh. Just as there is a control room number for beds, there should be one to attend to complaints of exorbitant bills. The government should bring private hospitals under the Mahatma Jotiba Phule Jan Arogya Yojana to make the schemes more meaningful and to avoid unjustified profiteering by those private hospitals who have chosen to stay out of the purview of these schemes.

The state is also likely to extend the capping on hospital charges and rates for Covid and non-Covid treatment in private hospitals for another three months. 
The scheme that allowed local authorities to take control of 80% beds in private hospitals and regulate treatment costs expires on August 31.

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