Private hospitals in Gurgaon have once again threatened to stop admitting new patients under the Ayushman Bharat scheme from June 5, escalating a standoff that could affect thousands of poor beneficiaries who rely on cashless treatment. The warning from the Indian Medical Association (IMA) has brought renewed focus to a long-standing dispute over delayed reimbursements, mounting unpaid claims, and a claims-processing system described as collapsing.
IMA's Letter to Health Authority
In a letter sent to the chief executive officer of the Ayushman Bharat Haryana Health Protection Authority (HHPA) in Panchkula on Friday, the IMA stated that empanelled private hospitals would stop fresh admissions under the scheme from midnight on June 5 if pending issues are not resolved. Haryana currently has around 1,300 hospitals participating in Ayushman Bharat, nearly 650 of which are private facilities.
Background of the Dispute
This latest threat comes just weeks after a similar protest in April, when the IMA pegged pending dues at approximately Rs 400 crore and claimed that claims dating back to September 2025 remained unpaid. According to IMA Haryana president Sunila Soni, some payments were released after that agitation, and dues until February were cleared. However, reimbursements have slowed again, pushing pending claims back to an estimated Rs 300-400 crore.
The association said that during an online meeting on April 16, officials had assured hospitals that most payments would be cleared before the next review. The IMA alleged that this promise was not honored. It also flagged several unresolved issues, including unpaid claims despite updated queries, pending TMS-1 cases, deductions in recently settled claims, and missed TMS-2 cases.
Processing Delays and Allegations
The IMA noted that claims, which should be processed within 15 days under the Memorandum of Understanding (MoU), are now taking three to five months. It attributed the delays to staff shortages, technical changes in the TMS-2 portal, delayed grievance hearings, and scrutiny by the SAFU wing. The body also alleged that clerical errors were being treated as fraud in some cases, exposing hospitals to de-empanelment.
Doctors stated that repeated payment disruptions are making it difficult for hospitals to continue under the scheme. They advised units unable to bear the financial burden to surrender their empanelment. Meanwhile, the HHPA said that payments are being processed continuously, substantial dues have been cleared, and delays are linked to medical scrutiny and audit under National Health Authority guidelines.
