Nagaland: Gauhati HC directs private hospitals to resume AB-PMJAY/CMHIS services

The Kohima Bench of the Gauhati High Court has directed the Nagaland Private Doctors Association (NPDA) to continue providing medical services under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) and Chief Minister Health Insurance Scheme (CMHIS), staying NPDA’s February 11 decision to suspend services due to non-payment of claims by the insurance provider.

The ruling came in response to a Public Interest Litigation (PIL) filed by ST Yapang, a resident of Changtongya currently residing in Kohima, seeking uninterrupted implementation of the AB-PMJAY/CMHIS in Nagaland. The petitioner argued that the suspension of services by empanelled private hospitals would severely impact the state’s healthcare system, particularly affecting beneficiaries entitled to cashless treatment under the scheme.

Background of the dispute
The AB-PMJAY was implemented in Nagaland in 2018 and later merged with CMHIS in 2022, providing cashless healthcare coverage of up to Rs 5 lakh per family per year for eligible beneficiaries, including government employees, pensioners, and indigenous inhabitants of Nagaland not covered under AB-PMJAY.

According to the PIL, the Nagaland Health Protection Society (NHPS) had selected Future Generali India Insurance Co. Ltd. through a national tender and signed a Memorandum of Understanding (MoU) on June 14, 2024, to implement the scheme. However, allegations of fraud, misuse, and lack of accountability surfaced, leading to the insurance company ceasing payment of claims to empanelled hospitals.

In response, the NPDA announced its decision to suspend AB-PMJAY/CMHIS services from February 15, 2025, citing prolonged non-payment of claims, reputational damage due to accusations of fraud, and a lack of involvement in decision-making processes.

Court proceedings and interim order
The petitioner’s counsel, Advocate Kezhosano Kikhi, argued that the non-payment of claims by Future Generali had caused uncertainty in the healthcare system, affecting both private hospitals and beneficiaries. The state’s standing counsel for NHPS, N. Mozhui, informed the court that NHPS had urged Future Generali to clear pending dues but had received no compliance thus far.

After hearing both parties, the bench comprising Justice Lanusungkum Jamir and Justice Kakheto Sema issued an interim order staying NPDA’s decision to suspend services. The court directed NPDA to continue providing healthcare services under AB-PMJAY/CMHIS in the “larger public interest” until further orders.

Additionally, notices were issued to the respondents, including the Chief Secretary of Nagaland, the Commissioner and Secretary of the Health Department, the Principal Director of the Directorate of Health and Family Welfare, the Chief Executive Officer of NHPS, Future Generali India Insurance Co. Ltd., NPDA, and the Union of India. The petitioner was instructed to ensure service of notice to Future Generali and NPDA within a week.

The matter is scheduled for its next hearing in four weeks.

MT