In a recent Delhi High Court judgement, Balaji Hospital and the Health Department were involved in a legal battle over the reimbursement of expenses for bariatric surgery. The court’s decision has significant implications for medical reimbursement guidelines. Let’s delve into the details of this important case.
Facts
- The Original Application filed by the respondent was allowed
- The petitioner was directed to process the claim for reimbursement of expenses incurred for bariatric surgery at Balaji Hospital
- The surgery was undergone by the respondent’s husband
Analysis
- The Tribunal allowed the respondent’s claim for a reimbursement of Rs.2,55,521/-.
- The Government issued guidelines for prior permission for Bariatric surgery procedures.
- The purpose of the guidelines is to prevent fraudulent claims for medical reimbursement.
- The applicant’s husband underwent Bariatric surgery after being examined by a Government Medical Officer.
- The surgery was performed at an approved panel hospital based on the urgency of the situation.
- The respondent did not have prior permission but was referred to the MCD panel hospital by the petitioner.
- The Tribunal considered the circumstances and directed the respondents to process the reimbursement claim if entitled as per rules.
- The respondent’s husband underwent bariatric surgery at Balaji Hospital within two days of approaching the hospital on referral from the doctors.
- Although bariatric surgery is not typically an emergency procedure, in this case it was deemed urgent for the respondent’s husband.
- The surgery cost Rs. 2,25,000 at Balaji Hospital, less than the approved rate of Rs. 3,00,000, justifying the Tribunal’s decision to allow the respondent’s claim.
Decision
- The petitioner has already deposited Rs.1,27,000 with the Registrar General of the Court on 15.12.2017.
- The deposited amount along with accrued interest will be released in favor of the respondent.
- The Balaji Hospital charged Rs. 2,25,000 for bariatric surgery.
- The balance claim of the respondent will be processed after verification.
- The petitioner is granted 8 weeks to pay the balance claim amount after adjusting the deposited Rs. 1,27,000.
Case Title: NORTH DELHI MUNICIPAL CORPORATION Vs. SUDHA SHARMA (2024:DHC:4119-DB)
Case Number: W.P.(C)-10565/2017
