Hospitals have free run in absence of grievance redressal system for patients getting overcharged in Delhi

COVID-19 patients in the national Capital who are being overcharged by private hospitals above the capped rates set by the Delhi government are suffering due to poor grievance redressal system in the state. Most patients have neither got any response from the state, nor have the hospitals refunded the excessive amounts charged from them.

The Aam Aadmi Party-led government in the Capital has not appointed anyone to handle such complaints. As there is no structured grievance redressal system, no one knows how many complaints have been received by the government. National Herald has been able to track at least 10 such cases.

On June 20, the Delhi government had ordered capping of COVID-19 treatment prices at private hospitals for 60% of the total beds. The daily rates for National Accreditation Board for Hospitals and Healthcare providers (NABH)-accredited hospitals were Rs 10,000 for isolation beds, Rs 15,000 for ICU without ventilator beds and Rs 18,000 for ICU with ventilator beds. The amount included cost of tests, nursing care, food, doctor visits, medicines and personal protection equipment (PPE). It does not include the price of experimental drugs.

In the case of non-NABH accredited hospitals, it was capped at Rs 8,000 for isolation beds, Rs 13,000 for ICU without ventilator beds and, and Rs 15,000 for ICU with ventilator beds.

However, several hospitals have not been informing patients about the capped rates. Sunny Guliyani’s 62-year-old mother Asha was admitted at Moolchand Hospital 10 days from June 29 to July 9. He was given a bill of Rs 3.73 lakh. As he was short of money, he paid using his credit card. Later, he converted it into a loan and now pays 24% interest on the loan amount.

The hospital did not inform Guliyani about the capped rates. “I came to know about the Delhi government’s rates from my insurance company. The insurance company would only approve the capped rates, but the hospital insisted that they would charge the regular amount for insurance holders. I was stuck. The insurance firm only approved Rs 1.22 lakh and I had to pay the rest of the amount,” rued Guliyani. He raised a complaint with the hospital authorities, but they were unwilling to listen. Instead, they gave him an 18-page itemised bill charging him for everything including bedsheets, sanitisers, masks, PPE, shoe covers, thermometer and syringes.

For over a month, Guliyani has been emailing his insurance company and the Delhi government’s grievance redressal officer Dr RN Das for the refund of the amount. His last e-mail to Das was on August 6. Das sent him Moolchand Hospital’s response on August 10. The hospital insisted that they had informed the patient that she can avail the capped rate on self-pay basis. The hospital added that the charges were as per the agreement between the hospital and the insurance company. They contended that they have not over-charged the patient.

Beyond this exchange, Das did not question the hospital on overcharging the patient and neither did he direct the hospital to refund the amount. “I emailed everyone, including the Delhi Chief Minister. It has been so difficult to get a response from the government,” added Guliyani.

But this is not an isolated incident. Nitin Gulati faced a similar problem with Moolchand Hospital too. His mother Tarun Lata was admitted for COVID-19 treatment from June 20 to June 30. Her bill came up to Rs 2.6 lakh, when she should not have been charged more than Rs 1 lakh. His mother was billed at more than Rs 20,000 per day.

“My insurance company would only approve the amount as per the government order. So, only Rs 1 lakh was approved. I had to arrange the rest of the amount – 1.6 lakh. After I complained to my company, the insurance firm approved another Rs 80,000. As a result, the hospital refunded Rs 80,000. I’m yet to get the remaining 80,000. I have complained to the authorities including Dr Das, but I have gotten no response,” Nitin said.

Patients admitted at several other private hospitals have faced this issue. Nitin Kumar’s family – father, mother, sister, brother – tested positive for COVID-19. His father, sister and brother were asymptomatic, so they quarantined at home. Nitin and his mother had to be hospitalised. He was admitted at Max Super Speciality Hospital and his mother Biney Rani at Max Smart, at Saket. Both were admitted from June 29 to July 2. Nitin was billed at the capped rates, so he had to pay Rs 35,000. But his mother’s hospitalisation for staying 3.5 days at the hospital was Rs 1.08 lakh. The hospital had not charged her according to the capped rates.

“The hospital had confirmed that they follow the capped rates. However, a day before the discharge, the hospital simply sent me a figure stating that this was the amount to be paid. Even though I had asked for the itemised bill, they said that they do not give the detailed bill before discharging the patient,” he said. As he was worried about his mother, he borrowed money to settle the hospital bill.

After his family recovered from COVID-19, Nitin sent complaints about Max Hospital overcharging him to all the state and central health ministers and secretaries. Additionally, complaint letters were sent to Dr Das, Delhi CM Arvind Kejriwal and Lieutenant Governor Anil Baijal. “If you go through the Delhi health website, it is impossible to find the nodal officer for such complaints. I sent my complaint on July 23. I have not got an acknowledgement or a response,” elaborated Kumar. Das sent an email to Max Hospital, but there has been no response from the hospital so far.

However, Dr RN Das of the Directorate General of Health Services insists that he has done his job. “The hospital has to refund the additional amount that they have charged as the government has fixed the rate. I respond to every complaint. If the hospital has not responded so far, they better respond soon and refund the amount. Hospitals don’t have a choice in this matter,” observed Das.

The issue is larger here. “The hospitals are charging more than what the Delhi government order states. Hospitals deliberately confuse people. In many cases, where patients don’t have insurance and if they don’t have access to civil society groups to help them, the situation becomes dire. In these COVID-19 times, how many people can afford treatment? The mental trauma cannot be imagined,” said Nitin.

“There is no redressal system in Delhi. The current system is what patients and their relatives have been trying to push through. They search for all email IDs and then send complaints to them. Dr Das has done nothing. He simply forwards the emails sent by the patients to the hospitals. If the hospital responds, he forwards that email to the patient. An officer’s job is not to simply forward emails,” highlighted Inayat Kakkar, who is a member of Jan Swasthya Abhiyan. She has been helping several patients file complaints. Jan Swasthya Abhiyan is a people’s health movement aimed at establishing equitable health access.

Even though Das has been responding to some of these complaints, the Delhi government has not issued an order appointing a nodal person to respond to these complaints. “As a result, there is no mechanism to keep a track of all the complaints. The Delhi government should be publicly reporting the status of the pending complaints and action taken. But here they haven’t even appointed an empowered person. The Delhi government must proactively initiate audits and audit all the bills since June 20, 2020,” added Malini Aisola, co-convenor of All India Drug Action Network.

“Non-compliance by private hospitals with government orders is a universal phenomenon being witnessed across the country. Empowered committees and teams led by IAS officers have been dealing with complaints in cities Bangalore, Mumbai, Hyderabad and this has led to crores being refunded to patients and action against hospitals,” added Aisola.

Several states have initiated action against private hospitals overcharging patients. After warning private hospitals several times against overcharging patients, Telangana government has taken over 50 per cent beds in all private hospitals of the state and reserved them for coronavirus patients.

The K Chandrasekhar Rao-led government received as many as 1,039 complaints, including overcharging,against private hospitals for COVID-19 treatment. The tariff charged will be as per the rates decided by the government. “To keep hospitals in check, Telangana barred certain hospitals from treating Covid-19 patients and publicly shamed them. That has to happen in Delhi too,” pointed out Aisola.

The Karnataka government too warned private hospitals that criminal cases would be registered against private hospitals if COVID-19 patients were not charged as per the government tariff. Maharashtra too had fined hospitals for over-charging patients for COVID-19 treatment.

However, in Delhi, despite repeated complaints against hospitals, no investigation or enquiry has been initiated. “Hospitals are using the insurance loophole, while the insurance companies are approving only the amount as per the government order. The Delhi government is not interested in enforcing their order,” remarked Kakkar.

Das said the hospitals in Delhi will respond in some time. “Naturally, when we have fixed the rate, nobody can charge you more than the fixed rate. If Max Hospital has overcharged a patient, they have to refund. The hospitals cannot differentiate between insurance and non-insurance cases. The rate is fixed and there is no ambiguity about this. It is as simple as that. There is no loophole,” reiterated Das.