Sanjivani Nursing Home Situated Sawadia Campus Behind Gopi Talkies Raigarh Vs State of Chhattisgarh

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RAGHVENDRAJAT Digitallysigned byRAGHVENDRA JAT

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2026:CGHC:14024

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NAFR

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HIGH COURT OF CHHATTISGARH AT BILASPUR

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WPC No. 2128 of 2020

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1 - Sanjivani Nursing Home Situated Sawadia Campus Behind Gopi Talkies Raigarh Through Its Prop. Purushottam Agrawal Aged About 56 Years, R/o House Number 56, Gajanand Puram Colony Kotra Road By Pass Raigarh, District : Raigarh, Chhattisgarh.

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... Petitioner(s)

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versus

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1 - State Of Chhattisgarh Through The Secretary, Department Of Health And Family Welfare, Mahanadi Bhawan, Atal Nagar, District Naya Raipur (Chhattisgarh). 492002, District : Raipur, Chhattisgarh.

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2 - The New India Insurance Co. Ltd., Through Its Chief Area Manager, Office At 2nd Floor, Phase- I, L I C Campus, Investment Building, Jeevan Bima Marg, Pandri, Raipur, District Raipur Chhattisgarh 492001, District : Raipur, Chhattisgarh.

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3 - Medi Assist India T P A Pvt. Ltd., Through Its Director, Office At I B C Knowledge Park, Tower D, 4th Floor, Bennerghatta Main Road, 4/1, Bengaluru, District Bengaluru, Karnataka- 560029, District : Bengaluru, Karnataka.

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4 - The Director, Health Care And Chief Executive Officer, Rashtriya And Mukhyamantri Swasthya Bima Yojna, Indravati Bhawan, Atal Nagar, District Naya Raipur (Chhattisgarh) 492002, District : Raipur, Chhattisgarh.

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5 - The Chief Medical And Health Officer, Raigarh, District Raigarh Chhattisgarh. 496001, District : Raigarh, Chhattisgarh.

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... Respondent(s)

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For Petitioner(s)	: Dr. N.K. Shukla, Sr. Advocate along
	with Mr. Dinesh K. Bole, Advocate.
For Respondent(s)/State	: Mr. Ujjawal Choubey, Panel Lawyer.
For Respondent No. 2	: Mr. Priyanshu Gupta, Advocate on behalf of Mr. B.N. Nande, Advocate.
For Respondent No. 3	: Mr. Satish Surya, Advocate on behalf of Mr. Yogesh Pandey, Advocate.

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Hon’ble Mr. Justice Amitendra Kishore Prasad

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Order on Board

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24/03/2026

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By way of this petition, the petitioner has prayed for following reliefs:-

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“10.1) The Hon'ble Court may kindly be pleased to call for the entire records regarding the impugned action of the respondent for the kind perusal of this Hon'ble Court. 10.2) The Hon'ble Court may be pleased to direct the Respondents to release the amount which was spent by the petitioner against the treatment of Beneficiaries under the above mentioned two schemes i.e. RSBY (Rashtriya Swasthya Bima Yojana) MSBY (Mukhymantri Swasthya Bima Yojana). Along with the interest which

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has been withheld by the Respondent.

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10.3) The Hon'ble Court may order costs of the petition to the Petitioner.

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10.4) The Hon'ble Court may pass any other relief which this Hon'ble Court deems fit and proper, in the interest of justice.”

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Brief facts of the case, is that, the petitioner entered into a service agreement with Medi Assist India Private Limited, a service provider of The New India Assurance Company Limited, which came into effect on 03.04.2015, was submitted online, and was duly signed by the representative of the respondent on 26.06.2016. The object of the said agreement was that the petitioner’s hospital would provide medical and surgical treatment to approved beneficiaries under the Rashtriya Swasthya Bima Yojana (RSBY) and the Mukhyamantri Swasthya Bima Yojana (MSBY), and would be reimbursed for the expenses incurred in providing such inpatient treatment, subject to the terms and conditions of the agreement. However, certain persons harboring ill will against the petitioner were instrumental in procuring the publication of news reports alleging irregularities in the claims submitted by the petitioner’s hospital under the aforesaid schemes. Consequently, on 22.11.2016, the respondent authorities issued a show cause notice pointing out certain alleged discrepancies in the claims. Thereafter, on 25.11.2016, during the pendency of the enquiry, the respondents temporarily suspended the petitioner’s hospital on the basis of alleged discrepancies and anomalies found during the enquiry, and in the said suspension

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order it was specifically mentioned that “Medi Assist India Pvt. Ltd. or New India Assurance Co. Ltd. will not be liable for any claims transacted with effect from 26.11.2016.” Subsequently, a Khatma report was submitted before the Judicial Magistrate First Class on 14.07.2017. Being aggrieved by the de-empanelment from the Rashtriya Swasthya Bima Yojana and Mukhyamantri Swasthya Bima Yojana, the Petitioner preferred an appeal before the State Government, wherein the State Government, upon due consideration, concluded that no irregularities had been committed by the petitioner’s hospital, held that the charges were unfounded, and consequently found that the order dated 10.12.2016, whereby the hospital was de-empanelled, was without lawful authority, and further recommended reempanelment of the petitioner’s hospital under both schemes. Despite this, the petitioner repeatedly submitted representations to the respondent authorities seeking release of pending claims pertaining to the treatment provided to beneficiaries under the said schemes prior to de-empanelment, however, no steps were taken by the respondents to clear the legitimate dues of the petitioner’s hospital, thereby necessitating the filing of the present petition.

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Learned counsel for the petitioner submits that the present petition may be disposed of with an appropriate direction to the concerned respondent authorities to duly consider and decide the representation/application submitted by the petitioner for

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reimbursement of the expenses incurred by the petitioner’s Nursing Home in providing medical treatment to beneficiaries under the Rashtriya Swasthya Bima Yojana (RSBY) and the Mukhyamantri Swasthya Bima Yojana (MSBY). It is further submitted that the petitioner’s Nursing Home presently holds a fresh empanelment under the said schemes, as is evident from Annexure P/16 and Annexure P/18 annexed to the petition, and therefore, there exists no legal impediment in processing and disbursing the legitimate claims of the petitioner. Learned counsel contends that despite rendering bona fide medical services to eligible beneficiaries and incurring substantial expenses, the petitioner has been unjustly deprived of reimbursement, and the inaction on the part of the respondent authorities in deciding the representation is arbitrary and unsustainable in law. Accordingly, it is prayed that this Hon’ble Court may be pleased to direct the respondent authorities to consider and decide the petitioner’s pending representation within a stipulated time frame, in accordance with law.

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On the other hand, learned counsel appearing on behalf of respondent No. 2 submits that the agreement executed between the parties contains an arbitration clause, which provides for resolution of disputes through the agreed arbitral mechanism, and therefore, in view of the existence of such an efficacious alternative remedy, the present petition is not maintainable before this Hon’ble Court. It is further contended that any grievance

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arising out of the contractual obligations, including the claims for reimbursement as raised by the petitioner, ought to be adjudicated in accordance with the arbitration clause, and the petitioner is at liberty to invoke the said remedy in accordance with law.

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I have heard learned counsel for the parties and perused the material available on record.

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Considering the facts and circumstances of the case, and further taking into account the necessity for expeditious resolution of the petitioner’s grievance, this Court deems it appropriate to dispose of the present petition with a direction to the concerned respondent authority, i.e., respondent No. 2, to consider and decide the claim of the petitioner strictly in accordance with law. The said exercise shall be undertaken and concluded within a period of 45 days from the date of receipt of copy of this order, ensuring due application of mind and affording the petitioner an opportunity of being heard, if so required.

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With this observation and direction, the writ petition is disposed of.

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Sd/-

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(Amitendra Kishore Prasad) Judge

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Raghu Jat

Sanjivani Nursing Home Situated Sawadia Campus Behind Gopi Talkies Raigarh v. State of Chhattisgarh

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Sanjivani Nursing Home Situated Sawadia Campus Behind Gopi Talkies Raigarh v. State of Chhattisgarh

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