General observations regarding Medical Bills in respect of Defence Civilians (NON-DAD): PCDA Circular
THE OFFICER IN CHARGE/COMMANDANT
(All Units under jurisdiction of central command)
SUB: General observations: regarding Medical Bills in respect of Defence Civilians (NON-DAD).
During scrutiny / audit of medical reimbursement claim the following observations are communally observed:-
1. Scrutiny certificate not found enclosed
2. Check list, MED 2004/97/MRC5 not attached/ not completed along with date and signed/ not countersigned
3. The specimen signature of competent authority not available or does not tally with the sample specimen signature.
4. The attested photocopy of CGHS card along with family photograph] family detail with D.O.B. not enclosed/not verified by unit authority.
5. Original Discharge/Emergency Certificate of the hospital in admission cases not enclosed.
6. The referral letter from CGHS dispensary not enclosed.
7. Original bills not attached or duplicate bills attached without certificate of lost vouchers as specified in FR-II RULE 43 and affidavit, for duplicate claim, on stamp paper.
8. The CGHS Package deal / CGHS Package no. For Pathological test not mentioned.
9. Original Discharge/Emergency certificate of the hospital in admission cases not enclosed.
10. Time barred sanction by Competent Authority (HOD) in case delay by more than one month / three month from date of discharge / treatment (in case of med advance).
11. Legal heir affidavit on stamp paper for claiming medical reimbursement claim along-with no objection certificate on stamp paper in case of death of card holder not enclosed.
12. 10% discount may be obtained from the hospital on the final bill on cash payment/advance taken from Govt as per MOA signed by the each hospital with.
13. In IOL implantation the sticker ID not attached [verified by operating surgeon along with name & type of IOL lens and the cash receipt.
14. All test copy may be enclosed.
15. The claim may please be forwarded to Addl. Director, CGHS (as per letter S-11012/91-CGHS (P) (Vol-I) dt 18/03/1992 para 3(xiii)).
16. Certified copy of Emergency Certificate is not found enclosed.
17. The pay slip of the employee showing pay in pay band and grade pay is not found enclosed for assessment of entitlement.
18. As per this Office Circular No.Pay/lv/Med/7007/Ord dt 23/05/2014 medical bill/final bill of hospital concerned (raised on or after 01/07/2014} received without printed PAN, TAN, TIN would not be entertained.
19. After discharge the CGHS reference is not enclosed for follow up treatment.
20. Intimation within 24 hours to concerned unit and CGHS wellness centre regarding emergency admission in hospital has not been found attached.
21. Heavy medicines have been tendered to the patient; therefore the amount of medical claim paid to the individual/hospital may please be assessed by Addl Dir CGHS (concerned city).
22. The CGHS doctor has not verified the (ATP) Cash Memos (ADD. DIR. CGHS LUCKNOW
Letter NO.3-151/2013-CGHS/LKO Dt 30/09/2013).
Therefore it is requested that the above points should be kept in mind before forwarding the claim to this office for reimbursement of claim to avoid unnecessary delay in disposal of medical claims raised by your office.
In this context the compendium regarding orders under CGHS and Medical Attendance Rules may also be consulted for guidance.
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