Vishakhapatnam Commission Holds Apollo Hospitals Liable For Not Charging CGHS Rates

Brief Facts:

Dangeeti Vijaya (“Complainant”), a former Gazetted Officer in the Indian Navy, retired from service and was entitled to terminal benefits and the privilege of availing medical facilities for herself and her husband. The Central Government Health Services (“CGHS”) under the Ministry of Health and Family Welfare issued health cards (Nos. 231863/P), granting the Complainant cashless treatment at Apollo Hospital (“Hospital”). However, on October 27, 2019, at 8:50 pm, the Complainant encountered a fire accident, leading to her immediate admission to the Hospital. The staff at the Hospital, after providing initial first aid, recommended special treatment for burn injuries, necessitating specialized equipment. Consequently, the Complainant was admitted to the ICU on October 28, 2019, and was asked to deposit an initial amount of Rs. 70,000/-. Despite notifying CGHS about her beneficiary status, the Hospital collected the amount from the Complainant and initiated treatment with a delay of 2 days. The Complainant was discharged on November 30, 2019, with a total bill of Rs. 15,82,895/-, with assurances that she could recover this amount from CGHS.

Post-discharge, the Complainant requested a refund from CGHS, which, after inquiries, issued a cheque of Rs. 9,94,102/- out of the total amount, after a considerable delay. CGHS also served a show-cause notice to the Hospital, calling for an explanation for the overcharging of treatment and acknowledged that there was a violation by the Hospital of the agreement terms. The further proceedings against the Hospital remained undisclosed to the Complainant. Left with no choice, the Complainant filed a consumer complaint in the District Consumer Disputes Redressal Commission-I, Vishakhapatnam, Andhra Pradesh (“District Commission”).

In response, the Hospital denied the allegations, asserting that the complaint was not maintainable as the Complainant breached the agreement by not disclosing CGHS beneficiary status or submitting necessary authorization at the time of treatment. It argued that the Complainant didn't disclose her CGHS status during the treatment. Apollo argued that they provided treatment in good faith and didn't overcharge. It asserted that they have no role in settling claims between the Complainant and CGHS.

CGHS argued that the Complainant took the treatment on credit and it became aware of the matter only after the Complainant submitted medical claims. According to CGHS, the claim was processed following the CGHS tariff, and the admissible amount was reimbursed to the Complainant. It asserted that it played no role in the excess charges collected by the Hospital.

Observations by the Commission:

The District Commission noted that the Hospital was obligated to provide treatment and diagnostic facilities to CGHS beneficiaries at rates fixed by CGHS. Specifically for pensioners under the CGHS scheme, healthcare centres were mandated to provide treatment on a credit basis. In the case at hand, the District Commission noted that the Hospital collected Rs. 15,82,894/- from the Complainant, thereby exceeding the terms of the agreement.

Further, the District Commission noted that although the Hospital charged the Complainant as a general patient, it was obligatory on the part of the Hospital to return the amounts collected over and above the prefixed charges, as stipulated in the agreement with CGHS. Therefore, the District Commission held the Hospital liable for deficiency in service for not returning the money excessively charged from the Complainant despite multiple requests by the Complainant.

Consequently, the District Commission directed the Hospital to return Rs. 5,88,793 to the Complainant with interest as charged by the nationalized banks. It was directed to pay a compensation of Rs. 25,000/- to the Complainant and Rs. 10,000/- towards the litigation costs incurred by the Complainant.

Case Title: Dangeeti Vijaya vs Apollo Hospitals and Others.

Case No.: CC/239/2021

Advocate for the Complainant: DNS Gupta

Advocate for the Respondent: CS Sekhar and Sreerama Murthy

Click Here To Read/Download The Order