IN THE HIGH COURT OF DELHI
Manmohan Sarin,Vipin Sanghi
Govt.of NCT of Delhi - Appellant
Versus
Prem Prakash - Respondent
WP(C)No. 13435-37/2006
WP(C)No. 12968-70/2006
Decided On : 20-08-2008
Article 226 - Reimbursement of the amount of medical expenses-- Expences incurred by Holder of medical facility card at the empanelled hospitals with treatment being authorised by the Government of NCT--No case is made out for inference in the exercise of writ jurisdiction with the orders passed by the Tribunal--It would be for the Government of NCT of Delhi to recover from the concerned hospital any billing in excess of the admissible rates under the scheme.
1. By this common judgment, two petitions namely “Government of NCT of Delhi and others versus Prem Prakash” being WP(C) No. 13435-37/2006 and “Government of NCT of Delhi versus G.R. Arya” being WP(C) 12968/70/2006 are being decided, since both involve the question of extent of reimbursement of medical claims to Government employees-ex employees. Vide orders dated 6.3.2006 in O.A. No. 1776/2005 and judgment dated 3rd February 2006, in OA No. 2242/2005 the Central Administrative Tribunal granted reimbursement of their expenses on medical treatment. The Tribunal allowed the applications of the respondents holding them entitled to be reimbursed the entire amount of medical expenses since these were incurred at the empanelled hospitals with treatment being authorized by the Government of NCT.
2. The Govt. of NCT of Delhi by these writ petitions, is seeking quashing of the orders of the Tribunal. In WP(C)No.13435-37/2006 referred to as Dr. Prem Prakash”s case, out of the total amount of Rs.2,76,444/- (Two Lac Seventy Six Thousand Four Hundred and Forty Four only) expended by the respondent for the treatment of his wife, the petitioner sanctioned the amount of Rs. 1,60,244/- (One Lac Sixty Thousand Two Hundred and Forty Four only). In WP(C) 12968- 70/2006, i.e. G.R. Arya”s case, the medical claim of respondent herein and his wife was reduced by the petitioner from Rs.4,12,934/- (Four Lac Twelve Thousand Nine Hundred and Thirty Four only) to Rs. 2,67,745/- (Twelve Lac Sixty Seven Thousand, Seven Hundred and Forty Five). The Tribunal vide the impugned orders, directed the petitioner, to reimburse the remaining amount of medical expenses to the applicants (respondents herein).
3. Before noticing the grounds raised in the present petitions, facts leading to the filing of the two petitions may be noted briefly: WP(C) No. 13435-37/2006 (i) Respondent is a holder of medical facility card and is entitled to avail medical facilities for himself and his family members. It is common ground that Escorts Heart Institute and Research Centre (hereinafter referred to as EHIRC) is an empanelled hospital. The respondent”s wife had suffered cardiac discomfort and was rushed to the EHIRC for diagnosis and treatment. She was admitted on 25.1.2004 and was suffering from unstable angina. On her condition stabilizing, an angiography was performed on 27.1.2004 and the coronary angioplasty was done on 29.1.2004 She was discharged from the hospital on 31.1.2004 The package rate as per the OM dated 7.9.2001 is stated to be applicable. (ii) The EHIRC raised a bill for Rs.2,76,444/- (Two Lac Seventy Six Thousand Four Hundred and Forty Four only) but the petitioners reimbursed only Rs.1,60,244/- (One Lac Sixty Thousand Two Hundred Forty Four only) as per the package rate. As noted earlier, the Tribunal had directed the payment of the differential amount. Vide orders dated 28.8.2006 in the writ petition, the petitioner was asked to deposit the differential amount in Court. Petitioner deposited the same. The EHIRC was made a party in these proceedings and its response was invited to seek clarification with regard to allegations of charging in excess of the package rates. The EHIRC claims that the bill has been raised strictly in terms of OM dated 7.9.2001 and there was no overcharging. (iii) We have had a look at the bill in question. The charges for two items in the bill catch our attention. Firstly, charges for an injection “Reopro” which is Rs.42,640/-and the cost of Cypher Stent, which is Rs.1,22,750/-. These two items are consumables in the bill at Sl. No.29 and 30. The questions arising are whether the charges are covered by memorandum of 7.9.2001 and if not, who is liable for the payment of the amount billed in excess of the package rate. We shall consider these aspects later in the judgment.
4. Let us notice the salient facts with regard to the WP(C)No.12968-70/2006, i.e. G.R. Arya”s case. WP(C)No.12968-70/2006 (i) Respondent G.R. Arya h
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