Demanding immediate reimbursement of over ₹23 crore dues pending since 2017 for paediatric surgeries done under Rashtriya Bal Swasthya Karyakram (RBSK), small and medium private hospitals in Karnataka have threatened to suspend their participation in the State’s health schemes.
The hospitals, which said they are left with no option but to take legal recourse, said if the dues are not cleared at the earliest, they will halt paediatric surgeries under the State’s Ayushman Bharat Arogya Karnataka (AB-ArK) health scheme.
The dispute dates back to 2016, when the State government introduced additional procedure codes under RBSK, a centrally-funded health scheme under the National Health Mission (NHM), without prior approval from the Centre. Private hospital authorities claimed that they acted in good faith on the published codes and provided critical services to ailing children between 2016 and 2018. However, audits later flagged that these codes lacked central clearance, leaving the claims stuck.
Technical glitch
Officials attribute the delay to a technical glitch in the listing of procedures on the portal of Suvarna Arogya Suraksha Trust (SAST), the nodal agency implementing the State’s health schemes. The issue is now before the government.
RBSK was launched in 2013-2014 to improve survival, growth and development of children in the 0-18 years group.
Focusing on the screening of infants, children and young adults for 4 D’s — Defects at birth, Deficiencies, Diseases, Developmental delays and Disabilities — the scheme initially covered a total of 40 medical procedures which subsequently increased to 104.
The scheme ensured children diagnosed with illness received follow-up care including early intervention services at the district level and including surgeries at tertiary level, free of cost under NHM. Services not available in government hospitals are made available in private empanelled hospitals.
Lack of clarity
Hospital associations contend that the responsibility for payment rests squarely with the State.
“The procedures were introduced by the State but not formally approved by the Centre. Hospitals performed the surgeries on the basis of the government’s own notifications. The lack of clarity over financial responsibility has led to mounting dues, pushing hospitals to the brink. The dues must be cleared without further delay. If hospitals take a legal recourse, the government will have to pay the dues with interest,” said Pavan Kumar Patil, a representative of the Indian Medical Association’s Karnataka chapter and member of the Karnataka Medical Council (KMC).
Despite repeated meetings with SAST officials and appeals to the government since 2018, payments have not been released. “The prolonged delay has caused severe financial strain on hospitals, with many providers having invested significant resources to ensure timely and quality care for children,” said L.H. Bidari, founder trustee of Yeshaswini health scheme. Dr Bidari’s hospital in Vijayapura has claims of over ₹54 lakh pending.
Fault on both sides
Harsh Gupta, Principal Secretary, Health and Family Welfare, acknowledged the protracted nature of the issue. “This is a seven-year-old matter.. Once patients were admitted, pre-authorisation approvals were granted from the government side and hospitals went ahead and performed procedures despite being aware that the procedures are not approved by the Centre. So the responsibility lies on both sides,” he said.
Gupta added that the matter is under review and will be placed before the State Cabinet. He clarified that if the Centre has not approved the additional procedures, the State government will have to bear the expenditure. The Hindu