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Thread: Reimbursement of Medical Bills

  1. #1
    Member abhijitdas_rlikol is on a distinguished road
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    Default Reimbursement of Medical Bills

    One Staffmember has submitted frequently some medical bills from AMA as well as State Government Hospital for reimbursement. On scrutiny HOO (Controlling Authority) was not satisfied for which he claimed empty container of medicines in support of those bills from the incumbent. The incumbent has denied to produce empty container of medicines in writing. This office stands with the decision not to reimburse the bills untill the incumbent produced the empty container. Now the incumbent requested several times in writing addressed to HOO as well as Hqrs. also to reimburse the bills. Please intimate what will be the next action be taken by this office.

  2. #2
    Senior Member jitendraacr is on a distinguished road
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    Dear friend
    Frquent medical bills can raise doubt to any one including the HOO who is responsible for reimbursement of these bills. Your office can ask in writing from the treating AMA/Govt. Hospital regarding geniuneness of claim made by the employee. Believe me in 9 out of ten such cases AMA replied negatively and clearly states that the amound claimed is fake.
    Jitendra

  3. #3
    Senior Member badri mannargudi is on a distinguished road
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    Quote Originally Posted by abhijitdas_rlikol View Post
    One Staffmember has submitted frequently some medical bills from AMA as well as State Government Hospital for reimbursement. On scrutiny HOO (Controlling Authority) was not satisfied for which he claimed empty container of medicines in support of those bills from the incumbent. The incumbent has denied to produce empty container of medicines in writing. This office stands with the decision not to reimburse the bills untill the incumbent produced the empty container. Now the incumbent requested several times in writing addressed to HOO as well as Hqrs. also to reimburse the bills. Please intimate what will be the next action be taken by this office.
    While I do not want to go into the veracity of the claim in the instant case, I am of the opinion that the Competent Authority (HOO in the instant case) may not be within his right to ask the claimant to produce the empty containers, for, the claimant can legitimately submit that the empty containers were disposed of as waste (thrown into dust bin ). If some body raids my home and demand me to explain the source of 25000 lying at my home and I tell that it represents the salary (disbursed by my office) and the raiding authority says he won't believe me unless I show him the envelope in which the cash was disbursed if the raiding authority wont accept any other argument/submission, then, I am afraid the HOO has not read the Rule book.
    Last edited by badri mannargudi; 03-09-2009 at 10:11 PM.

  4. #4
    Member mrajeev is on a distinguished road
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    Asking for the empty containers is NOT IN GOOD SPIRITS and is only to HARASS the claimant. If the HOO has any doubt, he can refer the case to the prescribing Doctors for further clarification/confirmation. However, as per my experience in Admin for over 3 years now, we face all these difficult rules regarding verification etc is only because of the 5-10% of the beneficieries making wrong claims. Even after the Government relaxing rules to some extent, in the last one year (Post 6th CPC relaxation) I had come across many LTC Claims, Medical Claims and CEA Claims (even with School Fee receipt in a Bill form, a book of 100 pages will be available for Rs. 10/- in the local statonary store claiming Rs.1000/- per month.

    Unless we, the Govt Servants, change our attitude, the Admin and Audit will have to keep a suspicious eye on every claim.

  5. #5
    Junior Member Neel is on a distinguished road
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    Default medical claims

    I think granting fixed medical allowance is the best option on the part of the Govt to avoid this. This will also reduce the burden of preparation of medical bills periodically in all the offices.

  6. #6
    Junior Member debuly is on a distinguished road
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    I would like to know whether this particular clause/rule for claiming medicine containers/phials/strips is in force till date. As far as my knowledge goes this rule has been withdrawn/relaxed in post 6th. CPC era. But one DDO/HOD has asked for the particular order wherein it has been stated that submission of medicine containers/phials has been abolished/withdrawn..... is there any such order.... kindly highlight upon this point and kindly refer to the order no. with date (if any).... Thanks & Regards.

  7. #7
    Junior Member TAPANFIO is on a distinguished road
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    Dear friend
    Recently one circular has been out within one or two months mentioning that central govt. employee can now retain original medical prescription while submitting the medical bill for claiming refund . If anybody posted the said circular or may mention the dopt circular no. then it would be very helpfull to our office colleagues

  8. #8
    Junior Member debuly is on a distinguished road
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    Default Regarding medical bill reimbursement for treatment at Govt. hospital

    A Central Govt. Employee suffering from Chronic Hypertension, Ischemic Heart Disease (IHD) and allied problems is availing his treatment from a State Government run Hospital nearest to his headquarter & Govt. Accommodation from the Doctor (Medical Officer) of the State Govt. run Hospital in the Hospital OPD. The employee visits the Hospital at an interval of every 2 (Two) months and visits the Doctor at his OPD Clinic with the Hospital OPD Ticket/Card for treatment. The employee submits the medical reimbursement bill to his office for reimbursement of the cost of medicines only. The controlling officer/DDO is of the view that as the employee is availing prolonged treatment from the same doctor, he is not entitled to get medical reimbursement bill.

    The point of contention is whether the employee is entitled to get medical reimbursement bill keeping in view that he is availing treatment for chronic heart disease, where prolonged conservative treatment is essential for survival, and that too from a Medical officer/Doctor in a State Govt. run hospital with an OPD ticket/card. Can the DDO/controlling office refuse his medical reimbursement bill even when he is availing treatment in a Govt. Hospital on the ground that it is a prolonged treatment under the same doctor/medical officer ?

    Comments with supported medical bill rules may kindly be given for suitable solution of the case.

  9. #9
    Senior Member Victor is on a distinguished road
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    Quote Originally Posted by debuly View Post
    A Central Govt. Employee suffering from Chronic Hypertension, Ischemic Heart Disease (IHD) and allied problems is availing his treatment from a State Government run Hospital nearest to his headquarter & Govt. Accommodation from the Doctor (Medical Officer) of the State Govt. run Hospital in the Hospital OPD. The employee visits the Hospital at an interval of every 2 (Two) months and visits the Doctor at his OPD Clinic with the Hospital OPD Ticket/Card for treatment. The employee submits the medical reimbursement bill to his office for reimbursement of the cost of medicines only. The controlling officer/DDO is of the view that as the employee is availing prolonged treatment from the same doctor, he is not entitled to get medical reimbursement bill.

    The point of contention is whether the employee is entitled to get medical reimbursement bill keeping in view that he is availing treatment for chronic heart disease, where prolonged conservative treatment is essential for survival, and that too from a Medical officer/Doctor in a State Govt. run hospital with an OPD ticket/card. Can the DDO/controlling office refuse his medical reimbursement bill even when he is availing treatment in a Govt. Hospital on the ground that it is a prolonged treatment under the same doctor/medical officer ?

    Comments with supported medical bill rules may kindly be given for suitable solution of the case.
    Pleae ask your Controlling Officer/DDO to quote the relevant rule/regulations/orders, etc. under which he is expressing his views.

    Victor

  10. #10
    Junior Member debuly is on a distinguished road
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    Thanks Victor ji..... Any more replies/comments please......

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