PGI Lags Behind in Recovering Funds for Cashless Treatment Under Ayushman Bharat Scheme

Chandigarh PGI which provides free medical treatment to patients under the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana, one of the country’s largest healthcare schemes is currently awaiting the release of crores of rupees in dues. According to a recently released audit report, as of March 31, 2025, 4,579 claims amounting to ₹25.61 crore were pending with the medical institution.

Of these, the states of Punjab and Jammu & Kashmir rejected 2,973 claims totaling ₹16.59 crore. As per the agreement between PGI and the National Health Agency, payments for treatment were supposed to be settled within 30 days; however, in numerous instances, the process remained stalled for months.

According to the PGI administration, many patients treated under the Ayushman Bharat scheme went directly home after being discharged from the hospital, bypassing the designated Ayushman counter. Hospital management states that the final verification of patients and the updating of necessary documents could not be completed during the discharge process.

Consequently, records related to patients’ treatment had to be subsequently gathered from various departments, resulting in significant delays in filing claims. In many cases, the required documentation could not be completed within the stipulated timeframe, leaving claims pending; meanwhile, some claims were rejected by the respective State Health Agencies on technical grounds.

Under the previous protocol, the mechanism for real-time verification of patients at the time of discharge was not sufficiently robust. To address this shortcoming, the TMS 2.0 system has now been implemented at the institute. Under this new system, biometric verification of Ayushman scheme beneficiaries at the time of discharge has been made mandatory. Before a patient is discharged from the hospital, their identity, treatment records, and all documents pertinent to the scheme will be immediately updated within the online system.

The audit report revealed that payments for claims submitted by PGI following the treatment of patients under the Ayushman Bharat scheme were not disbursed within the prescribed timeframe. As per the agreement between PGI and the National Health Agency, the claim amount was supposed to be released within 30 days; however, in many instances, payments remained pending for months.

This placed increased financial strain on the institute, leaving crores of rupees tied up for extended periods. The hospital administration states that the financial processes related to patient treatment have been adversely affected due to the failure to receive timely payments. Out of 4,579 claims pending as of March 31, 2025, the State Health Agencies of Punjab and Jammu & Kashmir have rejected 2,973 claims, amounting to ₹16.59 crore.

According to the report, the majority of these claims were rejected due to deficiencies in documentation, delays in verification, and the failure to complete prescribed procedural formalities. Consequently, PGI has been left waiting for payments amounting to crores of rupees. The institute notes that several claims are currently still pending with the respective agencies for reconsideration.

To rectify these shortcomings, PGI has now implemented the TMS 2.0 system. Under this new framework, biometric verification of beneficiaries under the Ayushman scheme will be mandatory at the time of discharge. Before a patient is discharged from the hospital, all relevant documents—pertaining to their treatment, identity, and scheme eligibility will be updated within the online system. This will ensure that claims are generated immediately and can be filed in a timely manner.

The institute asserts that with the implementation of TMS 2.0, the likelihood of delayed claim submissions and documentation errors will be significantly minimized. Currently, the claims pending with Punjab and Jammu & Kashmir remain under the active consideration of their respective State Health Agencies.

In addition to Punjab and Jammu & Kashmir, the Himachal Pradesh government also owes crores of rupees to PGI. This outstanding amount pertains to the treatment of 657 patients payments for which have not yet been released, despite the expiration of the stipulated deadline.

An agreement was signed between PGI and the Himachal Pradesh government in February 2024, under which patients covered by the Himcare scheme were to be provided with cashless treatment. The corresponding claim amounts were required to be disbursed within 30 days. During the financial year 2024–25, PGI submitted claims totaling ₹34.65 crore; however, it received only ₹27.42 crore. The remaining balance has remained outstanding for a considerable period.