Hospital Refund Husbands Ayushman Card Widow Wins Rs 5 5 Lakh

Holding that the conduct of the hospital has defeated the very purpose of the welfare scheme intended for economically vulnerable citizens, a Haryana District Consumer Commission of Charkhi Dadri has directed a hospital to refund Rs 5 lakh to a woman after it illegally charged her for treatment despite her late husband being an Ayushman Bharat beneficiary.

Dealing with a plea of a woman against the Positron Hospital, the presiding member Manjit Singh Naryal also ordered the hospital to pay Rs 50,000 compensation and Rs 10,000 litigation costs for mental agony and unfair trade practice.

“The object of the Ayushman Bharat Scheme is to provide financial protection and cashless treatment to eligible beneficiaries. Once the deceased was an eligible beneficiary and the hospital was an empanelled hospital under the Scheme, charging huge amounts from the complainant without proving exclusion of the treatment from the Scheme amounts to a clear deficiency in service and unfair trade practice. The conduct of the hospital has defeated the very purpose of the welfare scheme intended for economically vulnerable citizens,” the commission said on June 3.

The complainant, the wife of the late man, filed a complaint against the Rohtak-based Positron Hospital for denying the benefit of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY).

She and her late husband were beneficiaries under the scheme, entitling him to free medical treatment up to Rs 5 lakh. On June 12, 2024, the complainant’s husband developed serious health issues, including stomach pain and acute breathlessness, and was initially taken to Bhiwani and thereafter admitted on June 13, 2024, in Positron Hospital at Rohtak.

According to the complaint, despite being covered under the Ayushman scheme, she was illegally demanded and collected a huge amount of Rs 7.25 lakh on the false pretext that the amount would be refunded after approval under the scheme, whereas they were only entitled to receive the amount as per the scheme limit.

The complainant, under compulsion, arranged the amount by borrowing from relatives, and in the following days, the patient was discharged on June 25, 2024, without any improvement, and unfortunately died on June 26, 2024.

Thereafter, when the complainant demanded a refund of the excess amount of Rs 5 lakh, the hospital refused to refund and even stated that they do not provide treatment under the Ayushman scheme, where the Ayushman Bharat Haryana director and Chief Medical Officer (CMO) confirmed the entitlement of free treatment.

The hospital filed a written statement taking preliminary objections regarding maintainability, locus standi, suppression of true and material facts, absence of cause of action, misjoinder and non-joinder of necessary parties etc., and submitted that the present complaint is wholly misconceived, false, frivolous, vexatious, and an abuse of process of law, filed only to harass, defame and extort money from the answering the hopspital.

It was further pleaded that the complainant has not approached this Commission with clean hands and has deliberately concealed material facts and made false and misleading averments, hence is not entitled to any relief.

It is further averred that no deficiency in service, medical negligence, or unfair trade practice has been committed by the hospital, and the treatment was provided strictly as per standard medical protocol by competent and experienced doctors with due care and caution.

It was further submitted that at the time of admission, the attendants were clearly informed that the hospital was empanelled under the Ayushman Scheme only for specific specialities, i.e. Cardiology and Cardio-Thoracic Surgery, and since the patient was suffering from acute gastroenteritis with sepsis, the case was not covered under the said scheme, and the patient was admitted as a cash patient after due consent and understanding.

The ambitious Ayushman Bharat or National Health Protection Scheme aims to cover over 10 crore vulnerable families (approximately 50 crore beneficiaries) and provide health cover up to Rs 5 lakh per family per year.

The programme is being touted as the world’s largest health protection scheme. The benefits of the scheme are portable across the country, and a beneficiary covered under the scheme will be allowed to take cashless benefits from any public/private empanelled hospitals across the country.

This judgment matters because it upholds the rights of Ayushman Bharat beneficiaries to receive cashless treatment. By penalising the hospital for illegal charging and unfair trade practices, it ensures that welfare schemes for the economically vulnerable are not undermined by hospitals withholding evidence of scheme exclusions.

Consumers facing similar grievances may contact the consumer helpline in their respective states (Haryana contact: 1800-180-2087) or dial the National Consumer Helpline at 1915 for assistance.

Jagriti Rai works with The Indian Express, where she writes from the vital intersection of law, gender, and society. Working on a dedicated legal desk, she focuses on translating complex legal frameworks into relatable narratives, exploring how the judiciary and legislative shifts empower and shape the consciousness of citizens in their daily lives. Expertise Socio-Legal Specialization: Jagriti brings a critical, human-centric perspective to modern social debates. Her work focuses on how legal developments impact gender rights, marginalized communities, and individual liberties. Diverse Editorial Background: With over 4 years of experience in digital and mainstream media, she has developed a versatile reporting style. Her previous tenures at high-traffic platforms like The Lallantop and Dainik Bhaskar provided her with deep insights into the information needs of a diverse Indian audience. Academic Foundations: Post-Graduate in Journalism from the Indian Institute of Mass Communication (IIMC), India’s premier media training institute. Master of Arts in Ancient History from Banaras Hindu University (BHU), providing her with the historical and cultural context necessary to analyze long-standing social structures and legal evolutions. ... Read More