Health care system is failing veterans 22 Oct 19
https://epaper.thestatesman.com/2382966/Kolkata-The-Statesman/22TH-OCTOBER-2019#page/7/2
Health care system is failing veterans 22 Oct 19
In April this year, the MoD directed that the Ex-servicemen Contributory Health Scheme (ECHS), created for military veterans, handled by the Department of Ex-servicemen Welfare of the MoD, would function under army control but remain under the same department of the MoD for release of funds and approvals. This was possibly because the MoD wanted to avoid facing flak for their failure to provide promised services to veterans. They wanted the army to face veteran anger, while they remain silently in the background.
The ECHS was rolled out on 01 Apr 2003 intending to reduce dependency on overburdened military hospitals. Every member pays a one-time subscription for joining the scheme. Currently an officer pays Rs 1.2 Lakhs, a JCO Rs 57,000 and a Jawan Rs 30,000 to become a member.
Over the years, ECHS instead of improving, has faced deterioration mainly due to shortfall in allocation of funds and mismanagement in selection of hospitals. Multiple avenues of control and cumbersome procedures have added to woes of veterans seeking medical care.
The ECHS runs its facilities through 28 regional centres and 427 poly clinics across the country. It has over 2700 empanelled hospitals. The present situation is so grave that rumours are afloat stating the armed forces may be compelled to return to the old system of health care, implying dependence on overburdened military hospitals as the scheme faces financial shortcomings caused by lack of release of funds.
When the army took over the responsibility of the ECHS in Apr this year, it was handed pending hospital claims amounting to Rs 2200 Crores. It therefore asked for a budget of Rs 5700 crores, firstly to clear old dues and secondly to cater for health needs for the current year. It was allocated only Rs 3200 crores. The management had two risky options. If it clears pending bills, then it would have very limited amount for the current year and could cater for under six months of medical supplies. On the other hand, if it does not clear pending hospital dues, then hospital care would be blocked. In either case, it would face veteran wrath.
The dire situation was flagged by service chiefs to the finance ministry. Nirmala Sitharaman, as the finance minister, publicly announced an additional allocation of Rs 3500 crores, which remains just an announcement till date. Non-release of additional funds would result in an increase in pending healthcare bills and add to burdens in the long term. It would culminate in a dissatisfied veteran community who would turn against the government for its ill-implemented scheme.
There are already reports of empanelled hospitals turning down ECHS patients due to pending bills. Despite such negative reports, the present management has not blacklisted any hospital, as it still hopes to receive funds to clear dues and reinstate the system. Hospitals affiliated to ECHS have also been accused of faking healthcare charges. To counter this, strict measures have been instituted, yet they continue to occur. This remains a major lacuna.
Some ECHS polyclinics have restricted visits to a single doctor a day for its members. For aged veterans having multiple ailments, such restrictions only add to their daily woes. In addition, shortfall of medicine has led to patients being forced to purchase and subsequently claim the cost of medicine. This claim takes months to clear, adding to financial hardships.
ECHS has 17 Lakh members and with dependency its beneficiaries are approximately 54 Lakh. Thus, applying simple mathematics, even with a budget of Rs 4000 crore, each beneficiary is allocated medicine/treatment of just Rs 7400 annually. None of the members of ECHS come under any other scheme, yet the government refuses to release basic funding to meet health needs of aging veterans.
It is surprising that a system rolled out by the government, initial contribution for which has been made by each of its members, has been allowed to deteriorate to the level that its members are being compelled to run from pillar to post for medicines and clearance of claims.
Is this because the department of Ex-servicemen welfare, which is overall responsible for the scheme has not learnt from its errors and hence continues to falter? Or was it because none from the department are entitled for treatment in this facility?
The CGHS was the scheme whose model was copied in establishing the ECHS. CGHS still functions, maybe with hiccups, however not with the restrictions which have been imposed on ECHS patients, nor with the same problems of payment of bills. Therefore, is the government differentiating between the two schemes.
It is this shortfall in funds and lack of cooperation from the central government that compelled the army chief to announce the creation of veteran hospitals in the country. In the first stage four hospitals are being considered. Clearly, witnessing lack of government interest in fulfilling its promise to veterans, the army plans to construct these hospitals employing Canteen Trade Surplus (CTS) funds allocated to it.
Land and basic facilities for veteran hospitals already exist in the form of Base Hospitals, whose existing services would be transferred to service hospitals in the same city. These would then be established with a mix of serving and hired specialists catering to most ailments affecting veterans. Such a step would assist veterans only in certain states and regions, not across the country. Basically, the entire system needs an overhaul which aims at correcting its existing shortfalls.
A facility which was meant to resolve problems of aging veterans, who have served the nation with honour, has been turned into a spectacle and a classic case of management failure. Handing it over to the army to face the wrath of veterans is not the solution. The MoD, which is responsible for the system, must take responsibility and work towards re-energizing the system.
As a first step, additional funds to clear the huge backlog of bills must be released by the government. The next step should be to bring in midcourse corrections into the system.
About the Author
Maj Gen Harsha Kakkar
Retired Major General Indian Army
The Honourable Prime Minister Shri Narendra Modi Ji,
The Honourable Defence Minister Shri Rajnath Singh Ji,
The Honourable Law & Justice Minister Shri Ravi Shankar Prasad Ji,
The Honourable Health Minister Shri Harsh Vardhan Ji,
The Honourable Finance Minister Shrimati Nirmala Sitharaman Ji,
Shri Rajeev Attri
Under Secretary
EHS Section
Ministry of Health.
r.attri54@nic.in
The Honourable MD, ECHS
*ECHS HEALTH CARE – BOGUS REFERRALS – THICK AS THIEVES. HOW TO IDENTIFY, CATCH, PROSECUTE*
Respected Honourable Sir/ Madam,
References –
– G.O.I. Ministry of Health letter No Z15025/78/2019/DIR/CGHS dt 09 October 2019 asking for suggestions
– G.O.I. Dept of ESW D(WE) F No 18(54)/2018/WE/D(Res-1) dt 02 August 2018 – Change in system of Referrals.
– Termination of CROSS-EMPANELLMENT of Hospitals with neighbouring RC’s.
– SOP treatment policy dt 28 September 2018.
Paragraph 23(e)-
In case ECHS benificary wants to utilise any Empanelled Hospital outside RC, he/she will have to take referral for the city/ town where he/she wants treatment. Such referrals should have SIGNATURE of the patient to facilitate verification. However patient has to physically report to the Polyclinic closest to the hospital selected. Once he/she reports to the Polyclinic so selected, priority Referral form will be generated. OIC Polyclinic will not endorse name of Hospital on the referral form and the same will be treated an unfair practice.
Paragraph 29 –
Generation of Referrals – Generation and issue of referrals takes unduly long time.
Paragraph 29 (c) Once automation is done, patient will be given a referance code by the referance cell & there will be no need to carry Referral document. Person can go to any Empanelled Hospital in the city selected, give code and Referral will be generated.
– Central Organisation ECHS No B/49774/AG/ECHS/Referral/ Policy dt 29 January 2019 – Provision of Referral from ECHS Cells at Comd/ Base Hospitals.
(1) It is please requested to read communication’s on BOGUS Referrals which have been generated on UTI – ITSL Portal and Prior when it was MANNUAL.
(2)
(a) Prior to issue of G.O.I. Dept of ESW D(WE) F No 18(54)/2018/WE/D(Res-1) dt 02 August 2018 – Change in system of Referrals; it was mandatory that “CHOICE” of Empanelled Hospital was to be SIGNATURED by the ESM/ Dependants.
(b) On issue of G.O.I. letter ibid mentioned paragraph 1 (a), Central Organisation ECHS issued S.O.P. treatment policy dt 28 September 2018 to quote, “Paragraph 23(e)-
In case ECHS benificary wants to utilise any Empanelled Hospital outside RC, he/she will have to take referral for the city/ town where he/she wants treatment. Such referrals should have SIGNATURE of the patient to facilitate verification. However patient has to physically report to the Polyclinic closest to the hospital selected. Once he/she reports to the Polyclinic so selected, priority Referral form will be generated. OIC Polyclinic will not endorse name of Hospital on the referral form and the same will be treated an unfair practice”, unquote.
This paragraph implies that the ESM/ Dependants will signature REFERRALS for verification. What would the verification imply :-
(i) The authenticity of a REFERRAL.
Reason –
To ensure a bogus Referral is NOT Generated in the New Sham PROCEDURE of CENTRALISED REFERRAL I.D. at TRICITY & PAN India.
(ii) The signatures on the Referral generated by PARENT/ MOTHER ECHS Polyclinic are to be authenticated by the M.O. & OIC. These signatures can be later On line Billing be MATCHED with subsequent Medical bills as on the Referral by the Parent/ Mother Polyclinic.
Reason –
Bogus Referrals can thus be restricted though NOT STOPPED. For no security check has been installed by UTI – ITSL Portal in this regard. The COLLUSION of UTI – ITSL Portal thus is very apparent.
(iii) The ISSUING/ GENERATION of a REFERRAL by ECHS Polyclinic CHANDIGARH/ MOHALI directly to an ESM from outside his Area of Responsibility (OUTSIDE PATIENTS) is illegal, Malafide and a methodology to Generate ‘BOGUS REFERRALS’. What could the ‘Conflict of Interest’ of ECHS Polyclinic CHANDIGARH/ MOHALI be in the following cases :-
(ai) Convert Parent/ Mother Polyclinic IPD REFERRAL’s to OPD & issue an I.D.
(aii) After the patient has been on the road or Gurudwara for the night because of IPD Referral being changed to OPD (Records of cuttings on Referrals will be in custody of ECHS RC, Chandimandir & On line on UTI – ITSL Portal) . Next day issue an IPD Referral to an OUTSIDE Polyclinic patient. A break of Medical PACKAGE thus.
(aiii) Even for Planned Surgeries when a date is given; patients are not directed to bring a Mother/ Parent Polyclinic Referral under the garb of convenience to ESM.
(3) HOW TO IDENTIFY & CATCH BOGUS/ FAKE REFERRALS –
(a)
(i) PROCEDURE to adopt to catch bogus referral AFTER ISSUE of G.O.I. Dept of ESW D(WE) F No 18(54)/2018/WE/D(Res-1) dt 02 August 2018 by Central Organisation ECHS issued STANDING OPERATING PROCEDURE treatment policy dt 28 September 2018 to quote, “Paragraph 23(e)-
In case ECHS benificary wants to utilise any Empanelled Hospital outside RC, he/she will have to take referral for the city/ town where he/she wants treatment. Such referrals should have SIGNATURE of the patient to facilitate verification”, Unquote.
(iii) The UTI – ITSL Site will reveal that NO REFERRAL has been signed by ESM BENIFICARY in consonance with S.O.P. treatment policy mentioned above, since 28 September 2018 to date.
Without SIGNATURE OF THE BENIFICARY ie Sick patient ON THE REFERRAL as Instructed in S.O.P.; the counter check of verification of signature on the Medical bills tallying with signatures on Referral is NOT POSSIBLE under the Sham CENTRALISED I.D. PROCEDURE. The genuinity of Referral being the basic financial document to accrue a Medical bill comes into in question ? Thus All Referrals have to be seived/ shuffled for GENUINITY. The UTI – ITSL be tasked to make a list of UNSIGNED REFERRALS by BENIFICARY’s the Ex-servicemen/ Dependants and SIEVE –
How to Catch FAKE REFERRALS –
(b)
(i) All IPD REFERRAL’s of PARENT/ MOTHER ECHS Polyclinic changed with cutting from IPD to OPD Referral. I.D. number be noted, tabulated with bill amount.
(ii) OPD REFERRAL FOLLOWED by IPD Referral ISSUED ( Made by) with I.D. generated DIRECTLY ( Bypassing Parent/ Mother ECHS PC) by ECHS Polyclinic CHANDIGARH & MOHALI be tabulted. The I.D. Referances be taken against each ESM as automatically the same come ON LINE on UTI – ITSL Portal (against each ESM/ Dependant). This medical bill amount be noted.
MAL PRACTICE –
These details will substantiate Referrals of BREAKING OF MEDICAL PACKAGE followed by Manipulated medical bills.
(c) Next STEP HOW TO CATCH THE BOGUS/ FAKE REFERRALS.
(i) When the ESM has been given date of Operation/ surgery he is as per rule to go back to Parent Polyclinic for a REFERRAL. Than come to ECHS Polyclinic CHANDIGARH/ MOHALI for Centralised I.D.
(ii) REFERRAL’s ISSUED, GENERATED by ECHS Polyclinic CHANDIGARH/ MOHALI DIRECTLY would have in it the BOGUS Referrals. These will have to be caught by various means :-
(ai) Medical examination of ESM/ Dependants to see Surgery marks/ tell tale signs.
(aii) IPD Referrals I.D. generated on same/ next day following generation of an I.D. for OPD Referrals.
(aiii) Under the “GOOSE RUNNER” 50:50 money split Referrals on MISPLACED/ LOST ORGINAL ECHS Cards.
(d) One is in for ANOTHER BIG SURPRISE –
Where Bogus Referrals are made on Stents/ Earlier TKR etc. where the ‘Machine numbers of Medical devices parts’ have to be PASTED on medical bills. After removing the machine Number from medical devices and pasting on medical bogus bills the medical device become ‘SURPLUS’ with the Hospitals. Here is the SURPRISE ! These SURPLUS medical devices are utilised on civilian patients at low cost. Thus many who cannot afford fall lure to getting medical devices & such Operations at low cost. Thus on Medical devices two amounts are gobbled :-
(i) One Medical bill by Bogus/ Fake medical billing on ECHS/ CGHS, all Central Health Scheme’s on creation of Bogus Referral.
(ii) Another bill on utilising the SPARE Created medical device on Civilians (who are from weaker sections) at low cost.
Can one think on these lines. Never a God fearing human.
(4) Follow same PROCEDURE’s to catch Bogus/ Fake Referrals prior to issue of G.O.I. New policy on Referrals. When CHOICE of Hospitals was there upto raising of UTI- ITSL Portal installation in 2012. Prior in MANUAL Medical billing. The complete Government money looted can be assessed and recovered.
SOLUTION –
(5) There is no iota of doubt that the ONLY viable transparent solution left of such a COMPLEX issue of different humans ie. Subject to Army Act, Contractual, Civilians, Advocates, UTI- ITSL Portal, ECHS Card manufacturers etc can only be INVESTIGATED by a Central Investigative Agency. What better than the C.B.I. The Army has no where with all WHATSOEVER to Investigate different categories of people nor has it legal acumen to implement its findings in a Court of Law. That’s what the men in Uniform owe to there collegue’s now out of Uniform.
(6) MD, ECHS must be forthright to apprise repeatedly :-
(a) The Army Chief to proceed with C.B.I. Investigations.
(b) The Army Commander Western Command to procced with C.B.I. Investigations.
This path followed would show TRANSPARENCY. If one Waivers to follow a truthful path it would show COLLUSSION. Some APPROVER would be forthcoming during Investigations may be Dr Anil Joshi, M.O. ECHS Polyclinic, CHANDIGARH himself. Since he reported a Referral issue and earlier himself may be involved in such Bogus Referral issues.
(7) Please help in a C.B.I. Investigation, should I loose my life in this battle with odds and die a mysterious death/ be assainated. These communications would lead the C.B.I. to my killer. The communications be taken as my dying declarations. My loyalty towards the Government and Ex-servicemen health care has lead my conscience to write this communication to the most capable hands for detailed remedial measures, severe punishment to DEFAULTERS, crushing of illegality doers etc.
Yours faithfully till death does us apart,
A loyal Chowkidar of the Honourable Government
Thank you Sir, for your views. These are priceless. Hope acted upon
Sir the policy fordependents members to be re checked fake cases many
With you. There are almost 5 times the dependents on ECHS. We need to review the policy earliest
Making a rough staff check, approx 6000 soldiers retire every year. ₹ 1000/- pm monthly allowance caters for about 2200Cr, another 300 Cr comes from one time contribution. This caters for 2600 Cr. The government needs to allot another 2000 Cr to reasonably raise satisfaction level part of which may be met from canteen surplus. Even flag day funds may be channelised . Some out box thinking is required. Some funds may be invested in buying out for veterans. A bidet debate is necessary in this regard.
Agree with you. The scheme was started by the govt. How can it let it fail
THIS NATIONALIST REGIME RESPECTS TRISHAKTIS & ESM ; THENCE, GAVE US OROP DENIED FOR 4 DECADES .
SOME ESM WHO WHILE being coas / cns IN harness HAVING declared them Kargil Martyrs & some like AM KAK GONE TO SC OVER 370 / 36A obviously ARE BEHAVING LIKE ISI ; thence all this
LET US BRING DOWN ‘TONS OF BRICKS’ ON SUCH UNWORTHY SONS conducting like guns
Sir, I agree with you. Many of us lower our own image
The Honourable Prime Minister Shri Narendra Modi Ji,
The Honourable Defence Minister Shri Rajnath Singh Ji,
The Honourable Law & Justice Minister Shri Ravi Shankar Prasad Ji,
The Honourable Health Minister Shri Harsh Vardhan Ji,
The Honourable Finance Minister Shrimati Nirmala Sitharaman Ji,
Shri Rajeev Attri
Under Secretary
EHS Section
Ministry of Health.
r.attri54@nic.in
(Please make orders Whilst REVAMPING CGHS on this matter too)
The Honourable MD, ECHS
ECHS HEALTH CARE – NEXUS ADVOCATES, ECHS STAFF, EMPANELLED HOSPITALS, STATION HEADQUARTERS etc. ON CIVIL COURT STAY ORDER ECHS STAFF THE GOVERNMENT HAS BEEN TAKEN FOR A RIDE – ALL GURU’s NO CHEELA’s
Respected Honourable Sir/ Madam,
References –
– G.O.I. letter No M.O.D letter No 22D(06)/ 2015/ WE/ D(Res-1) dt 06 September 2018 lays down the Agreement between contractually engaged person and Station Commander for rendering services to ECHS Establishment
(1) G.O.I. letter No M.O.D letter No 22D(06)/ 2015/ WE/ D(Res-1) dt 06 September 2018 lays down the Agreement between contractually engaged person and Station Commander for rendering services to ECHS Establishment. This is binding on the ECHS Staff on Civil Court Stay orders to signature the G.O.I. Contract FORMAT. On paragraph 15 a ‘NOTE OF DISSENT’ can be given. But A CONTRACT has to be in place between ECHS Staff and the Station Commander. To my knowledge NONE Exists with Civil court Stay order ECHS Staff.
NEXUSES –
(2) The ADVOCATES Legal fees to obtain a Civil Court Stay Order for ECHS Staff are :-
(a) ₹25,000/- for SINGLE ECHS Staff.
(b) ₹15,000/- for COLLECTIVE (IN BUNCH) ECHS Staff. Can be verified from 11 DISCLOSED in bunch (COLLECTIVE) Civil Court Stay Orders at ECHS Cell, Patiala submitted on 01 October 2019 to the authorities. Yet about 12 Civil court Stay orders are undisclosed. Can be checked from the Court REGISTRY.
(c) Such are the low rates prevailing for an ECHS Staff to obtain a Civil Court Stay order. Thereafter look after the Health care of Ex-servicemen with total IMPUNITY. No VACATION of Civil Court Stay Orders TO DATE. Enjoy.
(3)
(a) The ECHS Staff after submitting his Civil Court Stay order is in ECHS Polyclinic endlessly.
(b) The OIC ECHS Cell, Station Commanders, Area Commander’s even FORGET to ensure :-
(i) That without a Legal Contract the Civil Court Stay order ECHS Staff is NOT ACCOUNTABLE for his duties in ECHS Polyclinic.
(ii) On top of that they are paid monthly EMOLUMENTS without a VALID Contract.
(iii) Thus all are GURU’s and NO CHEELA’S.
(4)
A FINANCIAL IRREGULARITY HAS THUS OCCURRED –
(a) There are innumerable ECHS Staff on Civil Court Stay Orders PAN India. The ‘CHAMPIONS’ are the MEDICAL OFFICERS/ DENTAL OFFICERS and PARA MEDICAL STAFF at TRICITY, Punjab, Haryana. It leads one to believe that the AIM to be in ECHS Service is ONLY to earn immensely on illegal incentives ie GOOSE. This can be only earned by signing REFERRALS to Empanelled Hospitals. This be ‘PLUGGED’ as explained below. Especially the ONCOLOGY, NEURO SURGERY, CARDIAC PTCA (STENTING) the Roaring business Referrals under the Sham ‘CENTRALISED REFERRAL I.D. SYSTEM’.
(b) ECHS Staff on Civil Court Stay orders ONLY have a Civil injunction to stay in ECHS Service till the STAY is VACATED. Has the hiearchy apprised the Government on the following :-
(i) That ECHS Staff on CIVIL COURT ORDERS are in Service WITHOUT A VALID CONTRACT/ ACCOUNTABILITY BINDING IN PLACE ?
(b) What FORMAT if ANY is being USED and got Signed/ use for his CONTRAUAL ACCOUNTABILITY ? NIL to my knowledge.
(c) How to pay them, without any Contract or Binding ?
(d) Can a Medical Officer SIGNATURE a Referral a Financial document accuring a Medical bill and lacs of GOVERNMENT EXPENDITURE ?
(e) OR IS IT ‘FREE FOR ALL’ WRIT of Civil Court Stay Orders ECHS Staff running.
(4) It would be no surprise in case Station Commanders, Area Commander’s have faultered, scared of CIVIL COURT STAY ORDER ECHS Staff and allowed them to perform duty with total impunity and no legal binding :-
(a)
(i) How have the following been allowed to sign Referrals without a G.O.I. Contract in place & without any legal Accountability since years. All such Referral Payments are illegal and be regularised under Government orders with strict punishments to the hiearchy who thus show COLLUSION :-
(i) Ex Col Dr Minhas, M.O. , Ex Maj Rashmi Puri, M.O. on Civil Court Stay orders at ECHS Polyclinic, Mohali.
(ii) Dr Manuraj, M.O. on civil court Stay order in ECHS Polyclinic, Pathankot.
(iii) ECHS Staff on Court Stay orders under ECHS Cell, Patiala.
(iv) PAN India ECHS Staff on Court Stay Orders.
SOLUTION –
(5)
(a) The Government should instruct the Uniformed hiearchy to ‘STOP FORTHWITH’ signatures of CIVIL COURT ORDER ECHS M.O.’s on REFERRALS. PLUG the ‘GOOSE HOLE’ FIRST. Referrals be signed by other M.O.’s so Goose goes ELSEWHERE.
(b) Only pay them MONTHLY EMOLUMENTS with limited conditions in contract. DEBAR Signture to ALL FINANCIAL DOCUMENTS for which they have taken a Civil Court stay order to make Goose in Health Care. They’ll run away in a jiffy.
(c) Detail the C.B.I. to ‘CATCH THE BOGUS’ Referrals. When TRICITY Civil Court Stay orders M.O.’s are caught then allow them to go “SCOT FREE”, as no legal contract exists. Give some ‘EYE WASH’ administrative action to Uniformed personnel.
(6) WRIT OF THE GOVERNMENT OF INDIA IS IN QUESTION ?
(a) G.O.I. letter No M.O.D letter No 22D(06)/ 2015/ WE/ D(Res-1) dt 06 September 2018 lays down the Agreement between contractually engaged person and Station Commander for rendering services to ECHS Establishment. IT HAS BEEN FLOUTED BY HAVING NO CONTRACT WITH ECHS STAFF ON CIVIL COURT STAY ORDERS. NO VIABLE EFFORTS HAVE BEEN MADE TO VACATE THE CIVIL COURT STAY ORDERS.
(b) THE CASE OF 16 M.O.’s on Civil Court Stay Orders of Himachal Pradesh HIGH Court Shimla orders have not been CONTESTED in the Supreme Court of India.
(7)
(a) The Civil Court Stay Orders obtained by ECHS M.O.’s be contested by the AG in the Supreme Court to show the ‘WILL’ of the Government towards Health care.
(b) The VACATION of Civil Court Stay orders would break the BACK of the he ‘GOOSE SYNDROME’ in Health care.
(8) May the Government take an INTERIM Action. Then a detailed report on ILLEGALITIES of signing of Referrals, Payments made without Accountability ie. A CONTRACT IN PLACE of ECHS Staff on Civil Court Stay Orders ie. जमाई’s in ECHS HEALTHCARE !
(9) Please help in a C.B.I. Investigation, should I loose my life in this battle with odds and die a mysterious death/ be assainated. These communications would lead the C.B.I. to my killer. The communications be taken as my dying declarations. My loyalty towards the Government and Ex-servicemen health care has lead my conscience to write this communication to the most capable hands for detailed remedial measures, severe punishment to DEFAULTERS, crushing of illegality doers etc.
Yours faithfully till death does us apart,
A loyal Chowkidar of the Honourable Government