Jai Ambey Multispecialty Hospital Vs the State of Chhattisgarh

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2025:CGHC:48145

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NAFR

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HIGH COURT OF CHHATTISGARH AT BILASPUR

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(Order reserved on 17/07 /2025) (Order Delivered on 18/09/2025)

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WPC No. 2153 of 2025

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Jai Ambey Multispecialty Hospital Through Dr. Ashish Sahu, Director of The Jai Ambe Multispecialty Hospital Devpuri, Gudhiyari, Raipur, District - Raipur (C.G.)

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... Petitioner

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versus

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1 - The State of Chhattisgarh Through Secretary, Department of Public Health and Family Welfare, Mantralaya, Mahanadi Bhawan, Nava Raipur, Atal Nagar, District - Raipur (C.G.) 492002

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2 - The Director Directorate of Health Services Cum Chief Executive Officer, Chhattisgarh State Nodal Agency, 4th Floor, Sector-19, North Block, Atal Nagar, Nava Raipur, Chhattisgarh, 492002

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3 - The Chief Medical And Health Officer District - Raipur (C.G.)

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... Respondents

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For Petitioner	: Mr. Sandeep Dubey, Advocate
For Respondents/State	: Mr. Praveen Das, Dy. AG

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Hon'ble Shri Justice Arvind Kumar Verma

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CAV Order

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Heard.

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By way of the instant petition, the petitioner is challenging the order dated 07/04/2025 passed by Respondent No.1 whereby the appeal preferred by the petitioner hospital against the order dated 08/10/2024

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Digitally signed byASHUTOSH ASHUTOSH MISHRA MISHRA Date: 2025.09.23 18:19:09 +0530

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has been rejected and the order dated 08/10/2024 passed by Respondent No.2 whereby the Respondent No.2 has imposed 8 times penalty against the excess claim value of treatment amount and suspension order of the hospital has been passed for 03 months from the date of order from the PM-JAY scheme, has been upheld.

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The brief facts of the case as projected by the petitioner are that the petitioner Hospital having all infrastructure which require for Multispecialty Hospital, having all facilities for 20 beds including 2 beds for intensive care unit (ICU) with extension of 2 more beds in case of extreme emergency. The petitioner's Hospital empanelled under the Pradhan Mantri Arugya Mitra (PMAM), Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB PM-JAY).

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The grievance of the petitioner is that the penal action has been taken against the petitioner's hospital is complete violation of the guidelines issued by the NHA under the Ayushman Bharat Pradhan Mantri Jan Arogya Yoyana as well as Dr. Khoobchand Baghel Swasthya Sahayata Yojana, the simple letter has been issued to the petitioner's hospital without supplying necessary documents, which is mandatory under the scheme, therefore whole action of respondent authority is without authority of law, without jurisdiction and complete violation of principle of natural justice. Because the respondent authority imposes one of the penalty of suspension for the period of 3 months as well as imposed 8 times penalty against the excess claim value of treatment amounts. The suspension period already completed, even the respondent authority not allowing the petitioner's hospital to run the

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Hospital under the AB PM-JAY scheme, which is without authority of law, without jurisdiction and complete violation of principle of natural justice. Hence this petition.

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Learned counsel for the petitioner would contend that as per the provision / guidelines issued by the NHA, the complete procedure for suspension / penalty / de empanelment has been provided, but without following the procedure prescribed by the NHA, a letter notice issued to the petitioner's hospital without providing necessary enquiry report as well audit report and impose the penalty which is without authority of law and without jurisdiction. He would next contend that the provision specifically provides that, "based on the investigation report received, if the SHA / Insurance Company / NHA observed that, there is sufficient evidence / suspicion of EHCP (Empanelled Healthcare Provider) including in malpractices, a show cause-notice shall be issued to the EHCP. All attempts will be made to issue show cause notice within 7 working days from receipt of investigation report and in case of any delay; report must be submitted to CEO SHA, citing the reasons for the same." He would next contend that without completing the disciplinary proceedings, which provides under the Provision of NHA, suspension for 03 months has been passed against the petitioner's Hospital. He would next contend that the allegation made against the petitioner's hospital is not come under the penalty prescribed against the empanelled hospitals, therefore the whole action is without authority of law and without jurisdiction and complete violation of principle of natural justice. He would next contend that in one clause the penalty prescribed, which has been mentioned in impugned order is relates to

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the excess claims against the expenditure of patients. Therefore the whole action is without authority of law and without jurisdiction and complete violation of principle of natural justice. He would next contend that in this case, the petitioner's hospital with the permission of respondent no. 2 and 3 through portal, treated the patients on emergency situation in extended beds under the ICU unit, therefore the category of penalty prescribed under the AB PM-JAY scheme is not attracted in the case of petitioner's Hospital, therefore the whole action is without authority of law and without jurisdiction and complete violation of principle of natural justice. He would next contend that respondent no. 1 not heard the matter in detail and passed cryptic order without analysing the entire facts and circumstances and passed impugned order, which is complete violation of Scheme and complete violation of principle of natural justice. He would next contend that petitioner's hospital having all necessary documents / permission to run the Multispecialty Hospital, therefore no question of violation of any of the provision under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana. He would place reliance on the law laid down by the Hon’ble Supreme Court in the matters of Deepak Ananda Patil V. State of Maharashtra {AIR 2023 SC 533} & District Appropriate Authority under the PNDT Act and Chief District Health Officer Vs. Jashmina Dilip Devda {AIRONLINE 2024 SC 308} ; law laid down by the Hon’ble High Court of Madhya Pradesh in Index Medical College Hospital Vs. State of Madhya Pradesh {Writ Petition No.748482023, decided on 07/07/2023}; & Jash Hospital Reserach Center Vs. Deen Dayal Swasthya Suraksha Parishad ‘Niramayam’ & Others {Writ

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Petition No.6430 of 2021, decided on 074/11/2023} ; and the law laid down by the Hon’ble High Court of Allahabad in the matter of Mukesh Tandon v. State of U.P. {AIR ONLINE 2021 ALL 366} and would submit that the action of the respondent authorities is in violation of the statutory provisions and the same deserves to be set aside.

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Per contra, learned State counsel would contend that on 24/07/2024 an inspection team visited the petitioner hospital, i.e., Jai Ambe Multispecialty Hospital, Devpuri, Durg, wherein, upon inspection it was found that only 02 ICU Beds were available but in the Transaction Management System "TMS" Portal the ICU beds were shown to be much more in comparison to the number of ICU beds available. He would next contend that the petitioner hospital had blocked the ICU package in wrongful manner as compared to the number of actual number of ICU beds available. He would next contend that it was found that on account of fake blocking of ICU beds the petitioner hospital has claimed amounts under the ABPMTAY scheme by playing fraud and therefore, 8 times penalty was imposed upon the petitioner hospital and the said hospital was also suspended for 03 months from the scheme of ABPMTAY. He would next contend that the petitioner hospital was duly intimated of this action / fraud by virtue of notice dated 08/08/2024 [Annexure R/3] by mentioning the name of the patients who have been wrongly shown to be treated in ICU beds under the scheme ABPMTAY. He would next contend that the petitioner hospital after being noticed by the authorities submitted its reply dated 13/08/2024 [Annexure R/4] by assigning vague and unsatisfactory reasons. The petitioner has admitted in para 5 of the reply that the 2

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ICU beds in the hospital were already occupied and therefore, the other patients who were admitted in the hospital were accommodated elsewhere in other beds. The petitioner has admitted that the operator of the hospital has committed error by admitting other patients and showing them to be admitted in ICU beds, without discharge of the previous patients. It has also been admitted that the operator of the hospital has made a mistake by blocking ICU beds. He would next contend that the Director, Health Services has imposed the penalty of Rs. 31,32,000/- upon the petitioner on the basis of the fake entries made by the petitioner and amount claimed by the petitioner hospital in lieu of the treatment in ICU beds under the ABPMTAY scheme. It is submitted that the amount claimed by the petitioner hospital from 15 patients by raising fake claims, have been duly calculated by assigning reason and vide communication dated 08/10/2024 the same has been forwarded to the petitioner hospital for taking necessary steps for deposit of the amount of penalty. He would next contend that the petitioner has been duly intimated / noticed by the authorities about the illegal act committed by the petitioner hospital and the manner in which fake claim amounts have been raised by adversely affecting public exchequer and misusing the scheme of the Government. He wold next contend that the petitioner hospital has accepted its mistake in its communication of Annexure R/1 as well as Annexure R/4. He would next contend that the scheme which is part of record prescribes under Clause 13-A that a committee would evaluate any complaints received. It is submitted that the instant is not a case where some patient or some individual has filed a complaint against the hospital, wherein, the

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provisions of Clause 12A would apply. On the contrary, in the present case, the authorities made a sudden inspection of the petitioner hospital and found that petitioner hospital was involved in a gross misconduct of raising false claim bills under the ABPMTAY Scheme, without having sufficient facility of ICU beds as claimed by them. It is undisputed that the petitioner hospital had only 02 ICU beds and could not have raised bills/ claims beyond the 02 ICU beds. Furthermore, the provisions contained under 12-G provides penal action, wherein,the Tabulation no. 03 provides for imposition of 8 times fine with respect to the amount of illegal claims AND suspension for 3 months. This aspect is evident from the document of Annexure R/2 filed by the State. He would next contend that the petitioner hospital has accepted its mistake and undisputedly instant is a case of misuse of government funds allocated for treatment of needy patients, wherein, Private Hospitals are given liberty of reimbursement of the treatments. Under no stretch of imagination the petitioner hospital can be allowed to escape from its liability of playing fraud with the patients as well as misusing the valuable funds of the State as well as Central Government which is specifically allotted for the treatment of needy patients under the ABPMTAY Scheme. He would next contend that it is submitted that the judgments relied upon by the petitioner is of no help as they do not deal with a situation where the premises of the hospital have been inspected by Medical Team and apparent shortcomings/ frauds have been committed by the petitioner hospital. He would lastly contend that present is not a case of receiving any complaint and initiation of proceedings under Clause 12 of the scheme. It is clear that proceedings

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have been initiated on the basis of the findings by the inspection team regarding commission of serious mischief and fraud by the petitioner hospital, therefore, the instant writ petition deserves to be dismissed.

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I have heard learned counsel for the parties at length and perused the documents with utmost circumspection.

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Relevant clauses of the Scheme are quoted herein below:-

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v- jkT; iath;u lfefr (State Empanelment Commitee) & lfefr esa eq[; dk;Zikyu vf/kdkjh] jkT; uksMy ,tsalh dh v/;{krk esa mi lapkyd ,oa vfrfjDr eq[; dk;Zikyu vf/kdkjh] jkT; uksMy ,tsalh ds nks vU; vf/kdkjh] fpfdRlk f'k{kk lapkyuky; ds nks vf/kdkjh] fo'ks"kKrk ds vk/kkj ij mPp Lrjh; lfefr] 'kkldh; fpfdRlky; lqn`f<+dj.k lfefr dks 'kkfey fd;k x;k gS A

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jkT; uksMy ,tsalh] jkT; Lrjh; iath;u lfefr ds ek/;e ls fuEu dk;Z lqfuf'pr djk,xh &

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A. ;kstuk ds 'kh?kz fØ;kUo;u gsrq le;&lhek ds vanj fpfdRlky; dk iath;u lqfuf'pr djuk A

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B. iathd`r fpfdRlky; }kjk ;kstuk ds fn'kkfunsZ'kkuqlkj lkekU; ;k fo'ks"kK fpfdRlk lqfo/kk gsrq fu/kkZfjr U;wure ekinaM iw.kZ fd;k tkuk lqfuf'pr djuk A

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C. iath;u] izfØ;k dh ikjnf'kZrk lqfuf'pr djuk A

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D. iath;u gsrq izkIr leLr vkosnuksa dk le;&lhek esa fujkdj.k djuk A

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E. fpfdRlky;ksa dh vihy dks le;&lhek esa lacaf/kr Lrjksa ij izLrq djuk A

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F. iath;u fn'kkfunsZ'kks esa vko';drkuqlkj la'kks/ku djuk A

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c- ftyk Lrjh; iath;u lfefr (District Empanelment

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Commitee)& ;kstukarxZr ftyk Lrj ij Hkh ,d ftyk Lrjh; lfefr dk xBu fd;k tkosxk tks fd] ftyk Lrj ij futh fpfdRlky;ksa ds iath;u lacaf/kr xfrfrf/k;ksa esa lgk;rk djsxh A

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ftyk lfefr esa eq[; fpfdRlk ,oa LokLF; vf/kdkjh] muds }kjk

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fu;qDr ,d vU; fpfdRlk vf/kdkjh] jkT; uksMy ,tsalh ds ftyk lgkgdkj ,oa ftyk ds uflaZx gkse ,DV ds lykgdkj ;k izfrfuf/k 'kkfey gksaxs A

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ftyk iath;u lfefr fuEu dk;Z lqfuf'pr djk,xh A

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A. jkT; iath;u lfefr ds fy, {ks= Lrj ij lR;kiu dj lR;kiu ,oa tkap] fjiksVZ vkWu&ykbZu iksVZy ds ek/;e ls miyC/k djsxh A

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B. ftyk iath;u lfefr fdlh fpfdRlky; ds iath;u gsrq vuq'kalk izLrqr djsxh A

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C. ftyk iath;u] lfefr ls izkIr fpfdRlky;ksa ds iath;u vkosnuksa dks Lohdkj] vLohdkj ;k iqu% fujh{k.k gsrq okil djus dk fu.kZ; jkT; ith;u lfefr }kjk fy;k tkosxk A

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12- fpfdRlky;ksa ds fo:) vuq'kklukRed dk;Zokgh dh izfØ;k &

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;kstukarxZr izkIr gksus okyh f'kdk;rksa dh lquokbZ ,oa dk;Zokgh lapkyd LokLF; lsok,a lg eq[; dk;Zikyu vf/kdkjh] jkT; uksMy ,tsalh dh v/;{krk esa xfBr jkT; iath;u lfefr }kjk dh tkosxh A lfefr }kjk vfu;ferrk cjrus okys fpfdRlky;ksa ij] muds }kjk fd;s x;s vid`R;ksa dh xaHkhjrk ds vk/kkj ij dk;Zokgh dh tkosxh A

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;kstukarxZr f'kdk;rsa fuEu ek/;eksa ls izkIr gks ldrh gS &

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d- ejhtksa }kjk fyf[kr f'kdk;r]

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[k- 104 vFkok vU; fu/kkZfjr Vksy Ýh uEcj ds ek/;e ls izkIr f'kdk;r]

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x- ;kstukarxZr lkW¶Vos;j esa esa yxk, x, vyVZ ds ek/;e ls]

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?k- ejhtksa dk Vhih, }kjk lR;kiu fd;s tkus ij]

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M- gsYiMsLd vkWijsVj ds ek/;e ls]

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p- fpfdRlky;ksa ds vkSpd fujh{k.k ls]

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N- NAFU, SAFU ,oa DAFU ds ek/;e ls Kkr vfu;ferrk @

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f'kdk;r]

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t- jkT; uksMy ,tsalh fdlh fpfdRlky; ds fo:) Field audit report, Survey report, Feedback report, iathd`r f'kdk;rsa] dkWy lsaVj] vkosnu] fyf[kr f'kdk;r] bZesy bR;kfn ;k vU; L=ksrksa ls izkIr

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tkudkjh ds vk/kkj ij f'kdk;r ekudj vuq'kklukRed dk;Zokgh izkjaHk dj ldrh gS]

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vU; ek/eksa ls izkIr f'kdk;r]

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v- fpfdRlky; ds fo:) f'kd;r izkIr gksus ij dk;Zokgh djus ds iwoZ fuEufyf[kr izfØ;k viukbZ tkosxh %&

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A. f'kdk;r izkIr gksus ds i'pkr~ vfu;ferrkvksa dh tkap djkbZ tk,xh] ftlds fy, jkT; iath;u lfefr }kjk ftyk iath;u lfefr] vkWfMV gsrq fu;qDr ,tsalh] vU; foHkkxh; ny] Vh-ih-,- vkfn dk lg;ksx fy;k tk ldrk gS A

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uksV & Vhih, 'kke 8 cts rd ;kstukarxZr iathd`r fpfdRlky;ksa esa tkdj ;kstukarxZr iznRr lsokvksa dk vkWfMV] tkap ,oa fujh{k.k dj ldrk gS A 'kke 8 cts ds mijkar tkap o fujh{k.k gsrq tkus ds iwoZ Vhih, dks jkT; uksMy ,tsalh ls fo'ks"k vuqefr fy;k tkuk vfuok;Z gksxk A

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B. jkT; uksMy ,tsalh }kjk fpfdRlky; dks leLr nLrkost lfgr Li"Vhdj.k gsrq dkj.k crkvksa uksfVl tkjh fd;k tkosxk A

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C. fpfdRlky; dks 7 fnol ds Hkhrj dkj.k crkvksa uksfVl dk tokc fyf[kr esa izLrqr djuk gksxk A

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D. fpfdRlky; ds fcUnqokj tokc ds vk/kkj ij jkT; uksMy ,tsalh }kjk fu.kZ; fy;k tkosxk fd] lacaf/kr fpfdRlky; ds fo:) izkIr f'kdk;r dks fujLr fd;k tkuk gS vFkok psrkouh i= nsrs gq, fo'ks"k fuxjkuh lwph (watch list) esa j[k tkuk gS vFkok viuk i{k j[kus o lquokbZ fy, izLrqr gksus gsrq lwfpr djuk gS A fo'ks"k fuxjkuh lwpuk esa j[ks x, fpfdRlky; ds Dyse ,oa vkadM+ks dks cgqr xgurk ls Vhih,@jkT; uksMy ,tsalh }kjk izfrfnu mlds Dyseksa dh izo`fRr ,oa vfu;ferrk dk v/;;u fd;k tk,xk rFkk fdlh Hkh Li"V vfu;ferrk ds laca/k esa jkT; iath;u lfefr dks lwfpr fd;k tk,xk A mDr fpfdRlky; dks fo'ks"k fuxjkuh lwph esa j[ks tkus dh lwpuk ,oa dkj.k psrkoruh i= ds ek/;e ls crkuk gksxk A

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E. xaHkhj f'kdk;r izdj.k gksus ij jkT; uksMy ,tsalh }kjk fpfdRlky; dks fcuk lquokbZ ds Dyse Hkqxrku jksdk tk ldrk gS rFkk mlds i'pkr~ fpfdRlky; dks 15 fnol ds vanj lquokbZ gsrq cqyk;k tk,xk A

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F. lquokbZ gsrq nks i{k fuEukuqlkj gksaxs &

i{k 1

i{k 2

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	jkT; iath;u lfefr	 lacaf/kr	fpfdRlky; ds lapkyd@Lokeh
		 lacaf/kr	fpfdRlky; ds fpfdRld

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lquokbZ ds nkSjku ;fn v/;{k ,d fo'ks"kK dh lykg dh vko';drk eglwl djrs gS rks 'kkldh; ;k futh laLFkkvksa ls fo'ks"kKksa dks cqyk;k tk,xk A

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G. jkT; lquokbZ lfefr }kjk lquokbZ ds 30 fnolksa ds vanj dk;Zokgh gsrq fu.kZ; fy;k tk,xk A lfefr pkgs rks mijksDr vof/k esa vfrfjDr lquokbZ djk ldrh gS A I. jkT; iath;u lfefr vfu;ferrk ik, tkus dh fLFkfr esa fuEu rkfydk vuqlkj dk;Zokgh dk fu.kZ; ys ldrh gS &

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iathd`r fpfdRlky; dh xfrfo/k;ka ,oa n.M ¼jkT; uksMy ,tsalh dks ns;½

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1- fgrxzkfg;ksa }kjk voS/kkfud udn Hkqxrku	Hkqxrku dh xbZ jkf'k fgrxzkgh dks okil djuk ,oa 3 ekg gsrq fpfdRlky; dk fuyacu	izFke ckj gsrq fu/kkZfjr n.M ds vfrfjDr lacaf/kr Dyse dks jstsDV djuk izdj.k dh xaHkhjrk ds vk/kkj i 6 ekg gsrq fpfdRlky; dk fuyacu	iath;u fujLrhdj.k @Black listing
2- iznk; ugh dh tkus okyh lsokvksa gsrq fcy izLrqr djuk	Dyse jstsDV djuk ,oa Dyse jkf'k dk 3 xquk n.M vkjksfir djuk ,oa 3 ekg gsrq fpfdRlky; dk fuyacu	Dyse dks jstsDV djuk ,oa Dyse jkf'k dk 8 xquk n.M vkjksfir djuk ,oa izdj.k dh xaHkhjrk ds vkk/kkj ij 3 ls 6 ekg gsrq fpfdRlky; dk fuyacu	iath;u fujLrhdj.k
3-Upcoding/upbunding/ vuko';d iSdst CykWd djuk	Dyse jstsDV djuk ,oa Upcoding / upbunding/vuko';d iSdst ds dkj.k gqbZ vfrfjDr Dyse jkf'k dk 8 xquk n.M vkjksfir djuk ,oa 3 ekg gsrq fuyacu	Dyse jstsDV djuk ,oa Upcoding / upbunding/ vuko';d iSdst ds dkj.k gqbZ vfrfjDr Dyse jkf'k dk 8 xquk n.M vkjksfir djuk ,oa 3 ekg gsrq fuyacu	iath;u fujLrhdj.k
4- ;kstuk ,oa lsok xq.koRrk ekudks dk ikyu u djuk v/kkslajpuk esa deh gksuk]	lq{e dfe;ksa dh fLFkfr esa nks lIrkg esa lq/kkj gsrq psrkouh] cM+h dfe;ks dh fLFkfr esa dfe;ksa dks iwjk djus rd fuyacu SEC/DEC o }kjk iq"Vhdj.k mijkar	dfe;ksa dks iwjk djus rd fuyacu ,oaSEC/DEC }kjk iq"Vhdj.k mijkar	iath;u fujLrhdj.k
5- fgrxzkgh dks HkrhZ ;k bZykt nsus ls euk djuk	psrkouh i= tkjh djuk	3 ekg gsrq fuyacu	6 ekg gsrq fuyacu
6- fpfdRlky; }kjk pqfuUnk iSdstksa ;k fo'ks"kKrk ij gh dk;Z djuk	psrkouh i= tkjh djuk	3 ekg gsrq fuyacu	6 ekg gsrq fuyacu

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I. mijksDr vfu;ferrkvksa ds vfrfjDr vU; izdkj dh vfu;ferrk ik, tkus ij ;kstukarxZr lacaf/kr iathd`r fpfdRlky; ij dk;Zokgh dk fu.kZ; lapkyd LokLF; lsok,a lg eq[; dk;Zikyu vf/kdkjh] jkT; uksMy ,tsalh }kjk fy;k tkosxk A

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II. ftu fpfdRlky;ksa ij vkfFkZd naM yxk;k x;k gks] muds yafcr Dyseksa dk Hkqxrku naM jkf'k izkr gks tkus mijkar gh fd;k tk,xk A III. iath;u fujLr fpfdRlky;kas ,oa fuyafcr fpfdRlky;ksa ds yafcr Dyseksa dk Hkqxrku muds vkWfMV djus ds mijkar gh lacaf/kr fpfdRlky;ksa dks fd;k tkosxk A vkWfMV dh izfØ;ks 2 ekg esa iw.kZ dh tkosxh A

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IV. fpfdRld }kjk xaHkhr fpfdRldh; ykijokgh@fpfdRldh; uSfrdrk ds mYya?ku ls lacaf/kr izdj.kksa dh tkap ,oa mfpr fu.kZ; gsrq NRrhlx<+ jkT; esfMdy dkmafly dks izf'kr fd;k tk ldrk gS A nks"kh ik, tkus ij l a caf/kr fpfdRld dk iath;u fujLr djus dh vuq'kalk dh tk ldrh gS ,oa lacaf/kr fpfdRld dk iath;u fujLr djus dh vuq'kalk dh tk ldrh gS ,oa lacaf/kr fpfdRld ds f[kykQ iqfyl Fkkus esa ,Q-vkbZ-vkj- ntZ djkbZ tk ldrh gS A

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V. jkT; uksMy ,tsalh dks fpfdRlky; dk ;kstukarxZr~ iath;u fujLr djus ds laca/k esa LFkkuh; ehfM;k esa tkudkjh Hkh izlkfjr fd;k tk ldrk gS ftlls fd fgrxzkgh ,oa vU; lacaf/kr laLFkk@O;fDr dks bldh tkudkjh izkIr gks lds A

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VI. jkT; iath;u lfefr }kjk fy, x, fu.kZ; dks lacaf/kr fpfdRlky; dks jkT; uksMy ,tsalh }kjk i= ds ek/;e ls lwfpr fd;k tk,xk A

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VII. fpfdRlky; }kjk xaHkhj vfu;ferrk cjrs tkus ij N-x- jkT; uflZax gkse vf/kfu;e ds rgr~ fpfdRlky; dk iath;u fujLr djus gsrq vuq'kalk Hkh dh tk ldrh gS A

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VIII. ;fn fpfdRlky; mlds fo:) fy, x, fu.kZ; ls vlarq"V gks] rks og jkT; iath;u lfefr dks fu.kZ; dh iqulZeh{kk gsrq fu.kZ; ds 7 fnol ds Hkhrj fuosnu dj ldrk gS A

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J. fpfdRlky; }kjk vihy & ;fn fpfdRlky; jkT; iath;u lfefr ds fu.kZ; ij vlger gks] rks lfepo] N-x- 'kklu] LokLF; ,oa

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ifjokj dY;k.k foHkkx dks vkosnu izLrqr dj ldrk gS A vihy fd, tkus ij lfpo] N-x- 'kklu] LokLF; ,oa ifjokj dY;k.k foHkkx }kjk vihy fujLr djus vFkok lquokbZ ds vk/kkj ij vafre QSlyk nsus dk fu.kZ; fd;k tk ldrk gS A

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K. fuyafcr@fu"dkf"kr fpfdRlky;ksa ds iquZiath;u dh izfØ;k &

¶100

i. lkekU; f'kdk;r dh fLFkfr esa & fuyafcr fpfdRlky; ¼o"kZ ls de dh fLFkfr esa½fuyafcr le;kof/k mijkar iqu% iath;u gsrq vkosnu dj ldsxk A

¶101

ii. 1 o"kZ mijkar iath;u dk uohuhdj.k u djkus ,oa 1 o"kZ gsrq fu"dkflr fpfdRlky;ksa dks uohu vkWuykbZu izfØ;k viukuh gksxh A 13- ;kstukarxZr~ f'kdk;r fuokj.k iz.kkyh &

¶102

jkT; uksMy ,tsalh }kjk ;kstukarxZr~ iathd`i fpfdRlky;ksa dh fofHkUu lel;kvksa ;k f'kdk;rksa ds fujkdj.k gsrq dqN f'kdk;r fuokj.k lfefr;ksa dk xBu fd;k tk,xk A lfefr;ksa dk fooj.k fuEukuqlkj gS &

¶103

¼1½ jkT; Lrjh; f'kdk;r fuokj.k lfefr State Grievance Redressal Committee (SGRC) & jkT; Lrjh; f'kdk;r fuokj.k lfefr dk xBu jkT; uksMy ,tsalh }kjk fd;k tk,xkA ftlds laca/k esa izeq[k tkudkjh fuEukuqlkj gS &

¶104

a. izeq[k lfpo ;k lfpo LokLF; ;k muds }kjk ukfer vU; vf/kdkjh blds v/;{k gksaxs A

¶105

b. vU; lnL;ksa esa eq[; dk;Zikyu vf/kdkjh ¼jkT; uksMy ,tsalh½ lapkyd fpfdRlk f'k{kk] lapkyd LokLF; laok,a] la;kstd ds rkSj ij SNA ds jkT; f'kdk;r fuokj.k vf/kdkjh (State Grievance Redressal Nodal officer SGNO) v/;{k }kjk vU; ukfer izfrfuf/k ;k vf/kdkjh 'kkfey gksxsa A (2) ftyk Lrjh; f'kdk;r fuokj.k lfefr District Review and Grievance Redressal Committee (DRGRC)- ftyk Lrj ij ftyk Lrjh; f'kdk;r fuokj.k lfefr dk xBu fd;k tk,xk tks fd] le;&lhek esa ;kstukarxZr~ iathd`r fpfdRlky;ksa ls izkIr f'kdk;rksa dk fujkdj.k djus gsrq dk;Z djsaxs A ftu izdj.kksa esa dk;Zokgh jkT; uksMy ,tsalh Lrj ls visf{kr gksxh] muds fy, ftyk lfefr }kjk vuq'kalk izsf"kr dh tk,xh A mijksDr lfefr dh lnL;rk ,oa cSBdks ds laca/k esa

¶106

14

¶107

izeq[k tkudkjh fuEukuqlkj gS &

¶108

a. lfefr esa ftyk dysDVj ;k vfrfjDr ftyk dysDVj ds led{k jSad @ Lrj okys vf/kdkjh lfefr ds v/;{k gksaxs ,oa izfr frekgh cSBd ysaxs A

¶109

b. vU; lnL;ksa esa ftys ds eq[; fpfdRlk ,oa LokLF; vf/kdkjh la;kstd ds rkSj ij ftyk f'kdk;r fuokj.k vf/kdkjh (District Grievance Redressal Nodal Officer DGNO) ftyk lykgdkj] ISA ds izfrfu/k ,oa DGRC lfefr }kjk vkeaf=r vU; O;fDr 'kkfey gksxsa A c. eq[; fpfdRlk ,oa LokLF; vf/kdkjh la;kstd }kjk lfefr dh izfrekg cSBd dk vk;kstu fd;k tkuk vfuok;Z gksxk A

¶110

Therefore, from perusal of the entire documents it is crystal clear that the submission of the petitioner cannot be accepted because under Clause 13-A a committee would evaluate any complaint received whereas in the present matter it is not so that where some patient or some individual has filed a complaint against the hospital, wherein, the provisions of Clause 12A would apply but the authorities made a sudden inspection of the petitioner hospital and found that petitioner hospital was involved in a gross misconduct of raising false claim bills under the ABPMTAY Scheme, without having sufficient facility of ICU beds as claimed by them and the petitioner hospital has accepted its mistake in its communication dated 13/08/2024 & 09/10/2024. It has come on record that the petitioner hospital had only 02 ICU beds and could not have raised bills/claims beyond the 02 ICU beds. Furthermore, the provisions of contained under 12-p provides penal action, wherein the tabulation No.3 provides for imposition of 8 times fine with respect to the amount of illegal claim and suspension of 03 months. Therefore, it fortifies the fact that the petitioner hospital has

¶111

15

¶112

committed misuse of government funds allocated for treatment of needy patients, wherein, Private Hospitals are given liberty of reimbursement of the treatments.

¶113

Therefore, considering the entire facts & circumstances of the case and the nature of misconduct / illegality committed by the petitioner hospital, this Court is of the considered opinion that the petitioner is not entitled for any relief from this Court and the respondents have not committed any illegality.

¶114

Accordingly, the instant petition being devoid of merits is liable to be and is hereby dismissed.

¶115

SD/-

¶116

( Arvind Kumar Verma)

¶117

Judge

¶118

Ashu

Jai Ambey Multispecialty Hospital v. the State of Chhattisgarh

Case brief

What is this about?

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Jai Ambey Multispecialty Hospital v. the State of Chhattisgarh

Case brief

What is this about?

What did the court decide?

What the court decided

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