Show cause served
Source: The Sangai Express

Imphal, November 05 2025: State Health Agency, Manipur has sent a show cause notice to Shija Hospitals & Research Institute (SHRI), Manipur concerning the hospital's denial of cashless treatment to PMJAY beneficiaries.

A formal letter signed by Kengoo Zuringla, Chief Executive Officer, State Health Agency, Manipur has directed the SHRI Managing Director/Chairman to show cause in detail within 1 week as to why action under Annexure-6 of the PMJAY Agreement and any other suitable actions should hot be initiated against the Officials.

According to Annexure-6 to the said Agreement, in case of extraction of illegal/unauthorized cash payments from the beneficiary, there shall be full refund and compensation 3 times of the illegal/unauthorized payment to the beneficiary for the first offence.

For the second offence, in addition to actions as mentioned for the first offence, there will be rejection of claim for the case.

For the third offence, there will be de-empanelment/black-listing.

In this regard, the record suggests that SHRI has committed this irregularity more than three times, it pointed out.

As per the letter, PMJAY beneficiaries, except dialysis cases, are denied cashless treatment by Shija Hospital.

However, preauthorization for such cases are raised by the hospital with the assurance that the package amount will be refunded to the beneficiary once the claim amount is credited to the hospital.

It further added that beneficiary audit post-hospitalization conducted through random sampling revealed that 73 (seventy three) PMJAY beneficiaries who underwent treatment in Shija Hospital during FY 2024-25 were denied benefits of cashless hospitalization under PMJAY.

It is worth noting that according to Section 2 of the Agreement with EHCP (Empanelled Health Care Providers), the empanelled hospitals should provide treatment/intervention to the beneficiaries in a complete "cashless" manner.

Cashless means that the required treatment/intervention shall be as per package rates and no payment shall be made by the beneficiary undergoing treatment or any family members till such time there is balance left in the sum insured.

It also recalled that a public notice issued by the State Health Agency on January 6, 2022 had instructed the empanelled hospitals to strictly adhere to the PMJAY guidelines and provide cashless treatment to the beneficiaries and further highlighted the consequences of failure to comply.

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