Point of Law: Concept of natural justice and observed that it is another name of common sense justice. The adherence to principles of natural justice as recognized by all civilized States is of supreme importance when a quasi-judicial body embarks on determining disputes between the parties, or any administrative action involving civil consequences is in issue.

JUDGMENT :

1. Heard Sri Anoop Trivedi, learned Senior Advocate, assisted by Sri Avneesh Tripathi, learned counsel for the petitioner, Sri Suryabhan Singh, learned Counsel for the respondent Nos. 1 and 5, Sri Arvind Kumar Goswami, learned Central Government Counsel for the respondent Nos. 2 and 4 and Sri Madhukar Ojha, learned counsel for the respondent Nos. 3, 6, and 7.

Order on Impleadment Application

2. With the consent of the learned counsels for the parties, the Impleadment Application No.2 of 2021 is partly allowed and the proposed respondent Nos. 6 and 7 are allowed to be impleaded.

This writ petition has been filed praying for the following relief:-

3. (I) To issue a writ, order or direction in the nature of certiorari, quashing the impugned order dated 24.12.2020 (Annexure-10 to the writ petition)passed by the respondent no.3.

4. Order on writ petition

With the consent of the learned counsels for the parties, this writ petition is being finally heard without calling for a counter affidavit.

5. Facts

Briefly stated facts of the present case are that according to the petitioner, he owns and runs a Hospital under the name and style of “Dayal Nursing Home, having its registered office A-1 H.I.G., Mundera, Prayagraj”. The aforesaid hospital is empanelled under the scheme of Central Government called as “Pradhan Mantri Jan Arogya Yojana (PMJAY)”.

Earlier the aforesaid scheme was known as Ayushman Bharat Jan Arogya Yojana. According to the respondents, on receipt of certain information from National Anti Fraud Unit (NAFU) with respect to the working of the petitioner’s hospital, the petitioner’s hospital was put on “Watch-List” of the State Anti Fraud Unit (SAFU). Super specialist was hired by the State Health Agency (SHA) i.e. Avighna Mednet (OPC) Pvt. Ltd, which submitted its analysis report. On the basis of alleged prima facie fraudulent activity, the empanelment of the petitioner’s hospital was suspended by order dated 04.12.2020 with immediate effect, by the State Health Agency.

6. According to the respondents, after the hospital was suspended from the empanelment, certain investigations were made, the statement of the petitioner was recorded on 09.12.2020 and certain evidences were collected. The field investigation was allegedly conducted on 09.12.2020. The field investigation report and comparative analysis (Desk Audit vs Case Sheets allegedly found in the hospital at the time of Hospital Audit) was submitted on 15.12.20202. Based on the aforesaid material, the empanelment of the petitioner’s hospital was cancelled, three times of the disputed amount was imposed as penalty and the entire amount was directed to be recovered by the impugned order dated 24.12.2020 passed by the Chief Executive Officer-SHA (Uttar Pradesh), Lucknow. Aggrieved with this aforesaid order, the petitioner has filed the present writ petition.

7. Discussion and Findings

It is admitted by the learned counsels for the parties that empanelment as well as action for de-empanelment is governed by the guidelines issued by the Central Government with respect to Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (ABPMJAY). Copy of the aforesaid guidelines has been produced before us by both the learned counsels for the parties, which is kept on record. The copy of instructions as produced by learned counsel for the respondent Nos. 3, 6 and 7 is also kept on record.

8. The process for disciplinary proceeding of the de-empanelment is provided in Para 1.10 of the aforesaid guidelines. Part-A of para 1.10 of the aforesaid guidelines provides for institutional mechanism. Part-B provides for steps for disciplinary proceedings, which is relevant for the purposes of the present case and is reproduced below:-

B.Steps for Disciplinary Proceedings

Pradhan Mantri Rashtriya Swasthya Suraksha Mission (PMRSSM)-Guideline

Step 1 - Putting the provider on “Watch-list”

Based on the claims, data analysis and/or the provider visits, if there is any doubt on the performance of a Provider, the SE