Faridabad: Jameel gripped his Ayushman card as he left his house for Amrita Hospital in Faridabad, Haryana. He was filled with dread—not about the cancer that was ravaging his body but whether the doctors would treat him.
Seven years after its launch, the Narendra Modi government’s ambitious Ayushman Bharat health insurance scheme for the poor is battling a crisis. Across India, more than 32,000 hospitals—both private and public—have been empanelled under the scheme, which offers annual coverage of up to Rs 5 lakh per family. But the pending bills have crossed Rs 1.21 lakh crore.
From Manipur to Rajasthan to Jammu and Kashmir, private hospitals are turning away patients because the government has yet to pay them.
Now, the eye of the storm has shifted to Haryana where both—the national Ayushman Bharat and a similar state scheme, Chirayu Yojana— have been crippled. Since 7 August, more than 600 empanelled private hospitals in the state have suspended the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) scheme, citing pending bills amounting to Rs 500 crore. Those that haven’t yet are threatening to halt services as well.
On 24 August, IMA staged a fiery protest in Panipat and empanelled hospitals burned the Ayushman Bharat MoU.
“The government is not releasing funds, resulting in delays in payments to private hospitals. The root of the problem is the persistent budgetary mismatch and the shortfall of money”
Of the 12 crore economically vulnerable families across the country, 1.364 crore beneficiaries are from Haryana.
“This scheme is suffering from systemic neglect and bureaucratic hurdles,” said Dr Suresh Arora, president of Haryana Ayushman Samiti, who is also a senior consultant (senior Ortho Surgeon) at Surya Ortho & Trauma Centre in Faridabad.
The crisis has pitted private hospitals against the government, doctors against bureaucrats. Lack of trust and transparency on both sides has exacerbated the issue, with officials accusing hospitals of presenting them with inflated bills. And patients are caught in the crossfire.
It’s a far cry from the promise of the scheme. In February this year, Prime Minister Modi had praised the Ayushman Bharat scheme in the Lok Sabha.
“The countrymen have saved about Rs 1.20 lakh crore, which they would have otherwise spent from their own pockets,” said Modi.
But in Haryana, beneficiaries are being turned away, surgeries under the scheme are being cancelled, and public hospitals are groaning under the sudden influx of patients who have nowhere else to go.
“Without urgent budgetary support, transparency, and faster claim settlements, the scheme–meant to provide free treatment to the poorest of the poor—risks collapsing, leaving millions without critical care,” warned Dhirendra Soni, secretary of the Indian Medical Association (IMA) Haryana chapter.
It’s the third time this year that private hospitals in Haryana have revolted against the scheme.
“The situation has been worsening since 2023 in Haryana. The government is not releasing funds, resulting in delays in payments to private hospitals. The root of the problem is the persistent budgetary mismatch and the shortfall of money,” said Arora.
Piling up of unpaid bills
Near the entrance of the Surya Ortho & Trauma Centre, where Arora consults, patients and families gather around a yellow poster on the wall. ‘Haryana government is not listening to our demands. On the instructions of IMA Haryana, treatment under Ayushman has been discontinued. Sorry for the inconvenience.’ It’s one of 38 empanelled hospitals in the city. The government owes it pending dues of Rs 20 lakh.
A handful of larger hospitals are still treating beneficiaries—for now.
“In my family, two people are struggling with cancer. Ayushman Bharat is the only hope for their treatment,” said Jameel’s daughter-in-law Neha, holding his documents and ID cards while waiting for their turn at the Ayushman ward of Amrita Hospital, a 2,600-bed facility inaugurated by Prime Minister Narendra Modi in 2023. It’s owed dues of Rs 18 crore under the scheme, Arora said.
Jameel, who is in his 60s, was visibly relieved when he found out that he would get his much-needed chemotherapy. In the last year alone, the scheme has covered Rs. 2 lakh worth of his cancer treatment bills. Her daughter-in-law showed the message of the remaining amount left under the scheme on her phone.
Faridabad factory worker Dharmveer, 41, was not so fortunate. He went to a private hospital in Faridabad for his fractured hand under the Ayushman Bharat scheme. But the hospital refused to accept his card. He had to register as a regular patient and pay out of pocket.
“Patients like me are facing a lot of problems. I am poor, so I got the Ayushman card made. But it is not useful when I need it the most,” he said. (while taking medicine from the chemist shop outside the hospital)
Meanwhile, talks between the IMA Haryana and the Nayab Singh Saini-led BJP government have reached a stalemate.
“We have issued a warning to the private hospitals that if patients are denied treatment, the government will take strict action,” said Ankita Adhikari, joint chief executive officer of Ayushman Bharat Haryana.
IMA officials were hoping for a positive outcome following a meeting scheduled on 19 August with senior officials of the Nayab Saini government. But talks were postponed. There is no next date decided by the government.
It’s not just about unpaid dues, said Arora. The package rates are too low to cover treatment costs and they’ve been the same since 2021.
“When we threaten to suspend services, then some part of the money is released. It has become a pattern now. This can’t be the way to run this huge scheme,” said Arora, while sitting in his hospital cabin.
In fact, after the IMA’s call on 7 August, the Haryana government released Rs 245 crore. But private hospitals are not appeased.
“Out of Rs 490+ crores pending on 7th, the Haryana government has been able to muster only Rs 245 crores. What about the rest amount? Absolutely clueless,” read an 11 August post on X by the Haryana branch of the Indian Medical Association.
The decision has the support of the national IMA headquartered in New Delhi. In a letter, IMA national president Dilip Bhanshali called the decision to suspend services a “just and rightful effort” to secure budgetary allocations and ensure timely payments.
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Deeper crisis in Haryana
“With the advent of Chirayu Yojana, 60 per cent of the Haryana population gets covered, which creates fund issues”
It all started on 28 July, when IMA gave the Haryana government 10 days to settle all pending dues, which had been pending for the last three months.
It was a U-turn from the initial years of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana’s launch. The scheme was so successful that it inspired the Haryana government to introduce the Chirayu Yojana in 2022, which extends the same benefits to families with an annual income of up to Rs 1.8 lakh.
“With the advent of Chirayu Yojana, 60 per cent of the Haryana population gets covered, which creates fund issues,” said Arora. In other words, the number of beneficiaries ballooned from 40 lakhs to 1.4 crore from 2022 to now.
“This created more pressure on private hospitals,” Arora explained.
The private hospitals of Haryana are facing multiple other issues under the scheme—deductions to rejection of claims.
“It’s not only the delay in payment but the heavy deductions in reimbursements,” said Arora, adding that the health department is sending back the claims with irrelevant queries. “If we claim Rs 20,000, they are cutting half the amount and giving flimsy reasons for their decision.”
Hospitals are facing delayed payments, arbitrary deductions up to 90 per cent despite prior authorisation and inadequate budget allocation, reads the 23 August statement of IMA Haryana.
In February, an IMA delegation met CM Saini to raise these concerns.
“Six months have passed but nothing has happened. We have given a 9-point memorandum to the CM and he assured us that he will solve the problem,” said Arora. IMA Haryana officials waited for things to improve. “But nothing changed.”
The private hospitals also raised the issue of non-fulfilment of MoU terms signed at the time they were empanelled. According to the MoU, the government has to pay the amount in 15 days. If the government failed to meet the deadline, the amount would be paid with 1 percent interest per week.
But private hospitals allege that the government has refused to pay the promised interest. Apurva Hospital, a multi-speciality facility in Faridabad is owed only around Rs 7 lakh from the government but the administration needs it for everything to run smoothly.
“We have not received the amount since last year. It is impossible to run the operations,” said Dr. Prem Kumar Magu, general surgeon at Apurva Hospital.
“We have to pay our staff. If the bills of a hospital remain pending for a year, how will the work be done?” said Magu.
Ankita Adhikari admitted that there has been a delay in disbursing claims, but blamed the hospitals for not following guidelines.
“Hospitals are not submitting proper documents for claims, so we raise queries. And this takes time to process,” she said. However, she also said that the private hospitals are raising inflated bills. “That’s the reason for deduction and rejection of the claims,” she said, adding that last year, the government received claims of Rs 1,500 crore, and approved Rs 1,300 crore. On the budget crunch, she said the government will ask for a supplementary budget in the upcoming session of the assembly later this month.
Crisis spreading across India
“You can name any state, the situation is the same. The biggest healthcare scheme of India is getting worse day-by-day.”
Similar faultlines in the scheme have emerged in other states as well, including Manipur, Rajasthan and Jammu & Kashmir.
Earlier this month, the Manipur chapter of the Association of Healthcare Providers – India (AHPI) issued a letter warning that they would temporarily suspend treatment benefits under the scheme from 16 August.
As many as 43 hospitals in the conflict-hit state are owed dues of around Rs 80 crore that have been pending for the last six months.
“We want to treat patients but we have no alternative as resources are limited in Manipur,” said Dr. Palin Khundongham, president of AHPI.
He added that at least 60-70 per cent of patients that private hospitals treat are under the PMJAY scheme.
Other North-eastern states such as Tripura and Nagaland are in a similar situation.
However, days before going on strike, AHPI officials received a call from the state’s health commissioner asking for 2-3 weeks to resolve the matter.
“We have decided to give some more time to the government, if this time issue will not resolve we will then stop the services. The ultimate thing is our survival, if things will go like this, we would not survive at all,” said Palin.
Even Delhi hospitals joined the scheme in April this year and are facing delays in payments. Also, the larger hospital chains in Delhi, such as Apollo, Sir Ganga Ram, have not joined this scheme yet.
Last year in August, the empanelled private hospitals of Jammu & Kashmir threatened to halt their services, claiming that the government owes them Rs 300 crore.
The situation got more complex when in March this year, the government removed four surgeries from the list for private hospitals and restricted them to government-run healthcare facilities. Following this rule, private hospitals suspended free medical services.
In Rajasthan, also, more than Rs 200 crore of private hospitals are pending.
On 20 August, the Heart Centre in Panchkula’s Civil Hospital also halted its medical services under the Ayushman Bharat scheme. The centre has pending overdues of around Rs 1 crore. The Heart centre is managed by a private agency and they refused to resume services even after the government’s assurance.
“You can name any state, the situation is the same. The biggest healthcare scheme of India is getting worse day-by-day. It needs proper budget, transparency and efficient mechanism to run, else private hospitals of more and more states will suspend the services,” said a senior doctor in a private hospital of Jaipur.
The Ayushman Bharat scheme is also prone to the highest number of frauds. The Modi government informed Lok Sabha in July that more than 9.84 crore hospital admissions worth over Rs 1.40 lakh crore were authorised under the scheme.
In February, the Chhattisgarh government penalised 33 private hospitals for fraud and fake claims. This was one of the biggest crackdowns the state has witnessed.
Since the launch of the scheme, out of fraudulent claims of Rs 562.2 crore, the Chhattisgarh hospitals logged Rs 120 crore. After Uttar Pradesh, Chhattisgarh recorded the second-highest fraudulent claims.
However, despite questions raised by private hospitals in north and eastern parts of India, the private hospitals of South India have not halted their operations yet. According to National Health Authority (NHA) data as of April this year, among the five top states that have the highest hospital admissions under the scheme, three of them are from south India – Tamil Nadu (88.75 lakh), Kerala (50.98 lakh) and Karnataka (49.96 lakh). Fraudulent cases registered in South Indian states are also fewer compared to other states in the country.
According to the data given in Parliament, 1,114 hospitals have been de-empanelled and 549 hospitals have been suspended for three or six months across the country.
The de-empanelled process is done with the help of district civil surgeons.
“We have a setup of a Fraud Control Committee to whom we send the information after the investigation,” said Dr. Jayant Ahuja, civil surgeon, Faridabad. He said the payment issue of the private hospitals is a policy matter and the district officials have no role in it.
Patients suffering
Vidyasagar Gupta, father of Kamal Gupta, a resident of Sonipat, suddenly fell ill on Monday.
“We went to three private hospitals but the hospital refused to treat us under Ayushman Bharat,” said Gupta, whose family has an Ayushman Bharat card.
He finally went to a district-run hospital but was met with a wave of patients like him. A senior doctor of Sonipat district hospital said that earlier 10-12 eligible patients used to come daily but now this number has more than doubled.
There aren’t enough surgeons, he said.
“The government should find a solution, otherwise, things will be worse,” he said.
Meanwhile, Haryana’s Public Health Minister Ranbir Singh Gangwa has appealed to the doctors to provide treatment.
“The government will pay the hospital bills soon, there is no need to worry about it,” said Gangwa.
But this time around, Haryana’s doctors want more than words.
(Edited by Ratan Priya)