Shimla: In a major policy shift, the Himachal Pradesh government has decided that items and services already funded through budgetary allocations to government hospitals will no longer be eligible for reimbursement under the HIMCARE scheme. The decision was taken in a meeting chaired by Chief Minister Sukhvinder Singh Sukhu on Thursday.
The move comes after the government found that hospitals were generating bills under the Himcare scheme for services already covered through their annual budgets, leading to a dual financial burden on the state exchequer. Officials said the same services were effectively being funded through two separate channels, putting additional strain on the state’s already tight finances.
Under the revised norms, claims will no longer be accepted for a wide range of services, including hospital registration fees, general ward bed charges, nursing and boarding, doctors’ and consultants’ fees, anesthesia, blood transfusions, oxygen, operation theatre charges, surgical instruments, medicines, diagnostic tests such as X-rays, MRIs and CT scans, patient meals, and pre- and post-hospitalisation expenses. The government has maintained that all these components are already covered under separate budget allocations provided to hospitals.
The government has also introduced stricter financial controls. Future claims will now be settled based on either the actual expenditure incurred or the fixed package rate, whichever is lower. Government hospitals have been directed to submit detailed bills to justify their claims. Expenses already covered under state-funded provisions will not be eligible for reimbursement under Himcare.
The issue of Himcare was heavily debated during the recent Budget Session of the Himachal Pradesh Vidhan Sabha. The Opposition accused the government of attempting to phase out the scheme. However, Chief Minister Sukhu rejected the allegations and instead accused the previous BJP government of irregularities amounting to ₹110 crore under the scheme.
Highlighting discrepancies, the Chief Minister recently claimed that official records showed hysterectomy surgeries being conducted on four male patients, raising serious concerns about fraudulent billing. He reiterated that the scheme will not be discontinued but will be restructured to remove loopholes and improve transparency.
The State Vigilance and Anti-Corruption Bureau has been tasked with investigating the alleged irregularities. The agency has already sought records from hospitals and the Health Insurance Society. An internal audit conducted by the government flagged cases of fake surgical claims at medical colleges and even the use of expired intraocular lenses in some procedures.
Launched in January 2019 by the previous BJP government, the Himcare scheme provides cashless treatment of up to ₹5 lakh annually per family at empanelled hospitals. It covers up to five family members and was designed to extend health security to those not covered under the Centre’s Ayushman Bharat scheme.
With the latest changes, the government has attempted to plug financial leakages while retaining the core benefits of the scheme, though concerns remain over how the revised norms will impact patients and hospital operations in the state.
