CGHS AT A GLANCE.BLOGSPOT.COM /004/E

"CGHS Cracks Down on Malpractices: New Guidelines for Empanelled Hospitals"

     The Directorate has observed alarming issues concerning the operations of certain CGHS-empanelled Healthcare Organizations (HCOs). Reports of fraudulent billing practices on the NHA portal, overcharging of beneficiaries, denial of treatment, and other grievances have been received.

 

      


       In light of these complaints, all empanelled HCOs are hereby directed to strictly adhere to the following guidelines:

 1. Provision of Services

    No HCO should deny treatment to eligible CGHS beneficiaries under any circumstances.

    In cases of patient death or coma, the signatures of the patient's attendant, along with their mobile numbers, must be recorded on the final bills for all services, including daycare, laboratory services, dialysis, etc.

2. Reporting Requirements

HCOs must report the following cases within 24 hours to the respective Additional Director’s office via email:

Non-referral cases

Emergency admissions and consultations

Direct admissions of beneficiaries aged 70 years and above, including inpatient card details

Cases not reported will not be processed for approval.

3. Bed Availability Display

Availability of beds across different wards and ICUs must be prominently displayed for the convenience of visiting patients.

4. Ward Entitlement

Beneficiaries must be provided treatment according to their entitled ward category. Downgrading to a lower category is not permitted.

5. Prescription Standards

Prescriptions should be written in generic names and in capital letters.

HCOs must not insist on specific medicine brands.

6. Acceptance of CGHS-Supplied Medicines

Medicines provided by CGHS must be accepted by HCOs.

If any CGHS-restricted medicine is declined, the HCO must furnish the purchase invoice. Reimbursement will be made based on the invoice amount.

7. Implants and Devices

If a beneficiary opts for an implant priced higher than CGHS rates, informed consent must be obtained stating that the extra cost is not claimable under CGHS. This consent must be attached to the bill.

8. Information Display

     HCOs must clearly display the following information on notice boards and at prominent locations:

Empanelled under: CGHS City

Charges: As per CGHS approved rates

Eligible for Credit Facility:

Pensioners, Ex-MPs, Sitting MPs, Freedom Fighters, serving CGHS/DGHS/Ministry  of H&FW employees, serving employees in emergencies, and other notified CGHS cardholders

Name and Contact of Nodal Officer

Escalation Matrix

Email ID of the Additional Director, CGHS

9. Nodal Officer Updates

    Any changes in the Nodal Officer’s name or contact number must be     reported immediately to the respective Additional Director.

10. Portal Data Entry

    Only the beneficiary’s phone number must be entered into the                 BIS/TMS portal.

11. Daily Photo Uploads

    Daily geo-tagged photographs of all admitted IPD cases must be             uploaded to the TMS portal.

    For OPD cases, photos taken on the same day must also be uploaded.

12. CGHS Help Desk/Kiosk

     HCOs must establish a dedicated CGHS Help Desk/Kiosk to assist            beneficiaries on their premises.

13. CGHS Card Handling

    Under no circumstances should HCOs collect or retain the hard copy         of a beneficiary’s CGHS card.

14. Adherence to Package Rates

No HCO is permitted to charge beneficiaries any amount beyond the package rates prescribed by CGHS.

15. Fraudulent Billing

Submission of fake bills or forged documents will be treated as financial fraud. Legal action, including the filing of FIRs, will be initiated.

Non-compliance with these guidelines may result in de-empanelment or blacklisting of the concerned HCO as per the terms of the Memorandum of Agreement (MOA).

All CGHS-empanelled HCOs are directed to ensure strict compliance with the above guidelines in the larger interest of beneficiaries and to uphold the integrity of the CGHS system.

                Quick Reference

     CGHS AT A GLANCE by Chandra Kant Bapat is an affordable and comprehensive guide.  It is available on Amazon and Flipkart with a 5-star rating.

 AMAZON: https://www.amazon.in/dp/9364521978?ref=myi_title_dp

FLIPKART : https://www.flipkart.com/product/p/itme?pid=9789364521970

        For a comprehensive guide on CGHS,  please buy and read  CGHS AT A GLANCE by Chandra Kant Bapat, available at an affordable price of ₹222.

 



CGHS BENEFICIARIES WELFARTE ASSOCIATION OF INDIA (CBWAI)

CBWAI (Central Government Health Scheme Beneficiaries Welfare Association of India) is a registered, all-India welfare association.

All are requested to join by clicking on link https://tinyurl.com/bde9r8vb



 


I kindly request all members and readers to go through this post and share your valuable views, suggestions, or questions in the comments section below. Your feedback will help improve the content and make it more useful for everyone. 

Regards,

Chandra Kant Bapat

National Coordinator, CBWAI












  

Comments

  1. Bakulchakraborty1501@gmail.com3 May 2025 at 16:49

    Complete guidelines for cghs beneficiary. Very useful and important information is given in this blog. Tq

    ReplyDelete

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