Irfan Tramboo

Srinagar, May 25: After action against private hospitals, several public hospitals in Jammu and Kashmir are now likely to face similar scrutiny, as the State Health Agency (SHA) has found patients were “denied” cashless medical care benefits under the AB-PMJAY-SEHAT scheme.
The SHA, in this regard, has issued show cause notices to at least 11 hospitals across J&K, including SKIMS, Soura, for “denying” patient access to benefits under the scheme.
SHA has noted 14 such cases at SKIMS, Soura, where the benefits of the scheme have allegedly been denied to patients, leading to out-of-pocket expenditure, a violation of scheme guidelines.

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The hospitals in Kashmir that have been served notices include SKIMS, Soura; SKIMS Medical College, Bemina; SMHS Hospital; JLNM Hospital, Rainawari; Super Speciality Hospital, Shereen Bagh; and Children Hospital, Bemina.
Those in the Jammu division served with notices for incurring out-of-pocket expenditure by “denying” patient access benefits under the scheme include Associated Hospital, GMC Rajouri; SMGS, Jammu; Associated Hospital, GMC Udhampur; Govt Hospital Gandhi Nagar and GMC Jammu.
SHA, in the notices issued, has stated that it received a Tele-calling Findings report from Paramount Health Services & Insurance TPA Pvt. Ltd., conducted between April 17, 2025 and April 30, 2025.
“And… the report has highlighted instances of out-of-pocket expenditure incurred by the aggrieved beneficiaries admitted to your hospital under AB PM-JAY/AB PM-JAY SEHAT Scheme,” SHA stated in notices issued to all these hospitals on May 14.
It further informed that the aggrieved complainants stated the mentioned hospitals have denied patients access to cashless medical care benefits under the scheme.
“…such denial of treatment or imposition of out-of-pocket expenditure is a violation of the scheme guidelines and warrants appropriate action under the applicable rules,” the SHA noted.
The hospitals that have been issued show cause notices have been asked to submit a written response within seven days of receipt of the notice.
“Failure to provide any response to the show-cause notice or satisfactory explanation will result in further action, including but not limited to: imposition of penalties, suspension of your hospital from AB PM-JAY/AB PM-JAY SEHAT Scheme, or other legal actions as deemed necessary,” the SHA warned.
The SHA has also provided a list of cases mentioned in the report that led to complaints against the hospitals.
The highest number of complaints listed is for SKIMS, Soura-14 cases-followed by five cases at SMHS; one at SKIMS, Bemina; two at Associated Hospital, GMC Rajouri; three at Super Speciality Hospital, Shereen Bagh; one at SMGS, Jammu; three at Children Hospital, Bemina; one at Associated Hospital, GMC Udhampur; two at JLNM, Hospital, Rainawari; one at Govt Hospital, Gandhi Nagar; and six at GMC Jammu.
When contacted, the CEO of SHA and the State Nodal Officer did not share any details with Excelsior or confirm whether the hospitals have submitted their replies.
Officials from SMHS, however, dismissed allegations of denial of treatment, stating that in the listed cases, either the beneficiary had exhausted the package or the cost of the medicine exceeded the daily limit.
Earlier, such notices were also issued to various empaneled private hospitals across J&K, and in many cases, heavy fines were imposed and the hospitals were de-empaneled.
The action was taken after it came to the fore that these hospitals were incurring out-of-pocket expenses and denying treatment to patients-a similar situation now faced by the empaneled public hospitals.
The SHA also recently reserved four commonly sought surgical procedures under the scheme exclusively for public hospitals in J&K.
The Government in the Legislative Assembly justified the move by stating it was intended to “enhance transparency” and “uphold ethical medical practices,” while noting that public hospitals are capable of handling the additional responsibility.