Kohima, 17 April 2025: Nagaland Health Protection Society (NHPS), jun Department of Health & Family Welfare, Government of Nagaland laga under te ase, etu pora general public aru stakeholders khan ke janai di ase ki Chief Minister Health Insurance Scheme (CMHIS) aru Ayushman Bharat Pradhan Mantri – Jan Arogya Yojana (AB PM-JAY) under health insurance claim settlement te delay karone Future Generali India Insurance Co. Ltd. (FGI) uporte concern ase.
Scheme shuru hua pora CMHIS aru AB PM-JAY Nagaland manu khan karone equal access di ase quality healthcare services te. Kintu, FGI pora legitimate claims settle nokora karone, empanelled hospitals khan operational aru financial problem face kori ase, juntu beneficiaries khan ke bhi affect kori ase.
Main kotha aru NHPS pora loi thaka action khan:
Outstanding Claims Status (14th April 2025 tak):
Total Claims Submit kora: ₹178.96 Crores
Total Claims FGI pora approve kora: ₹147.65 Crores
Total Claims FGI pora payment kora: ₹99.28 Crores
Total Claims Pending (under process/approve kora kintu payment pending): ₹48.81 Crores
Total Claims FGI pora reject kora: ₹8.40 Crores
December 2024 te, FGI koishe ki kunba hospital fraud claim submit kori ase aru etu “fraud dossiers” submit kori ase. NHPS etu matter turan recognize kori gina, nijor internal audit team aru district authority pora verify korise. Findings te paise:
Majority claims jun FGI pora fraud koi thakise, etu to original/genuine ase aru to NHPS pora already investigate kori thaka claim ase.
Insurer pora bishi allegation to documentary proof pora support kuranai.
NHPS pura cooperation di thakishe aru joint verification mechanism offer korishe, kintu FGI response kuranai.
FGI claim payments rokhi ase “alleged fraud” reason te, jun contract terms aru National Health Authority (NHA) laga guidelines laga against te ase, karon etu fraud cases to properly prove honai. Eitu delay FGI laga cooperation na thaka karone bhi bishi biya hoishe, jodi age te FGI pora agreement te joint physical audit pora problem resolve koribo koishe.
State Government repeatedly assurance di ase ki genuine fraudulent claim recover koribole aru punishment dibole juntu laga dorkar ase, aru Nagaland Private Doctors’ Association (NPDA) bhi koishe ki guilty hospitals ke punish koribo. Kintu FGI osa claim nedia hoishe arbitrary rejection nathake kina.
State Government pura ₹91.99 Crores premium FGI ke pay korise, contract laga terms te.
NHPS accountability ensure koribo, misuse of public funds laka against te thakibo, kintu FGI laga blanket claim payment rokha action ke oppose kori ase karon etu patients aru empanelled hospitals ke effect kori ase. Already, NHPS duita (2) hospital ke 6 month karone suspend kori dishe, aru duita (2) hospital laga recovery initiate kori dishe. Etu ongoing ase aru prove kora fraudulent claim uporte aro recovery koribo.
Resolve koribole NHPS laga action khan:
Government/Regulatory Level te:
Issue formally escalate korise-
Insurance Regulatory and Development Authority of India (IRDAI)
National Health Authority (NHA)
Department of Financial Services (DFS), Ministry of Finance, GoI
Sob relevant documents aru claim status share korishe etu agencies logot regulatory intervention nimite.
Contractual aru Legal Recourse:
NHPS legal aru contractual options examine kori ase ki NHPS aru FGI laga service agreement te kora maintain kori ase. Penal aru remedial action laga deliberation choli ase.
Service Continuity aru Beneficiary Advisory:
Nagaland te health care delivery laga stakeholder hisap te, NHPS sincerely appeal kori ase sob private EHCPs (Empanelled Health Care Providers) ke ki service continue kori thakibo jabole department etu non-payment issue resolve koribo effort loi ase.
Jodi kunba empanelled private hospital cashless service (CMHIS/PM-JAY) provide nokoribo koi thakile,beneficiaries khan ke advise kora ase ki Government Hospital, CIHSR Dimapur, noile toh bahar laka empanelled hospital visit koribole. Sob Government Hospital, CIHSR Dimapur aru bahar laka empanelled hospital khan uninterrupted aru fully cashless treatment continue koribo.
NHPS, Government of Nagaland laga taraf pora, manu khan ke assurance di ase ki claim disbursement process normalize koribo, insurer ke accountable banabo, aru ekta eligible citizen bhi CMHIS/AB PM-JAY under te timely aru quality healthcare deny nokoribo.
Aro information nimite NHPS helpline 1800-202-3380 te contact kuribo paribo.
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