Sanpada hospital suspended from state health cover scheme

NAVI MUMBAI: Officials of the Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) have suspended MPCT Hospital in Sanpada from the health insurance scheme. The decision came after a surprise visit by the Yojana’s CEO, Sudhakar Shinde, on Wednesday, who allegedly found that the hospital had demanded money from a cancer patient from Amravati, Firoz Khan (46) despite pre-authorisation under the scheme.

According to the suspension notice issued by Paramount Health Services, TPA for the state scheme, Khan, who suffered from mouth cancer, had availed chemotherapy services in November 2019, which was not provided by the hospital though he was an eligible beneficiary. ‘The hospital told him that this procedure is not covered under the scheme and only surgery and radiation is covered. He underwent chemo thrice and paid Rs 1.05 lakh, that is Rs 35,000 for each cycle. He also incurred expenses of Rs 12,000 and Rs 8,000 for PET scan,” the notice said.

It also stated that a pre-authorisation was raised on February 12, but on the same day, Khan was asked to pay Rs 90,000 at the cash counter. Two days later, he paid Rs 50,000. The hospital did not provide any bill or receipt to the patient. Khan was operated on February 17under MJPJAY.

When Shinde, without disclosing his identity, visited the hospital, he met Khan’s relatives. They told him that a staffer had demanded Rs 50,000 more from them. “We are carrying out an inquiry and are looking at other cases too. They were collecting money illegally over and above the state package...Strict action will be taken against the hospital,” he said.

MPCT Hospital CEO Dr Prince Surana claimed these were allegations. “The patient underwent a chemo and made some payment as there is a limit to number of patients admitted under the scheme at a time. Besides, he has given in writing that no money was charged from him at time of admission. A head-neck surgery was carried out and he has not paid for any treatment availed under MJPJAY. Whatever has been paid was rightly for chemo, which was not claimed in scheme, as he had a ration card issue and there was a waiting,” he said. “We have 80 patients in treatment and if there was an issue, it should have been with all of them.”