The office of the Principal Director of the Audit (Central), Chandigarh, in its latest report, has pointed out that the PGIMER has failed to recover the outstanding claims of Rs 25.61 crore for the treatment of patients under the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) as on March 31, 2025.
The audit report of the Postgraduate Institute of Medical Education and Research (PGIMER) for the period 2021-22 to 2024-25 states that a memorandum of understanding (MoU) was executed between the National Health Agency (NHA) and the institute for providing services under the Ayushman Bharat-National Health Protection Mission (AB-NHPM). The source state of the AB-NHPM beneficiary will be responsible for payments for patient care.
During checking of the records made available by the PGIMER, it was noticed that Rs 25.61 crore from 4,579 claims as on March 31, 2025, was lying pending for recovery from various states on account of treatment provided to the patients under the Central scheme.
As per the agreement, the payment of the claim amount should be made to the PGIMER within 30 days after receiving all required information/ document. However, even after the lapse of the stipulated period, the payment has not been made by the states concerned.
The audit report further reveals that of Rs 25.61 crore in respect of 4,579 claims, Rs 16.59 crore (in 2,973 claims) was rejected by the states of Punjab and Jammu and Kashmir. Efforts were made by the PGIMER to recover the unpaid claims from the various states.
The institute says claims are lodged from multiple counters in the PGIMER round the clock. In some instances, patients were directly discharged from wards and never visited the Ayushman counter. Claims in these cases were done after retrieval of files and other clinical data from treating departments, which led to the delay in claim filing in these cases.
Now, biometric authentication has been made mandatory during discharge at the PGI and there is no scope for late submission of details. Further, the institute says that claims from J&K and Punjab are under active consideration of the respective State Health Agency. Final recovery of these claims is, however, awaited.
Similarly, the PGIMER also failed to recover outstanding claims worth Rs 4.02 crore from the Himachal Pradesh Government for the treatment of patients under the Mukhya Mantri Himachal Health Care Scheme-HIMCARE.
It was observed that Rs 4.02 crore pertaining to 657 cases was outstanding as on September 8, 2025. Of a total of 657 cases, claims worth Rs 3.88 in 629 cases were outstanding for more than 30 days as on September 8, 2025.
The Institute stated that the matter had been taken up with the Chief Secretary of Himachal Pradesh from time to time.
