General Observations on Medical Bills in respect of Defence Civilians – PCDA writes to all field formations

Principal  Controller  of Defence  Accounts has pointed out common defects in the Medical Bills submitted in respect of Defence Civilians (Non DAO)

Office  of the  Principal  Controller  of Defence  Accounts (CC) Cariappa Road,
Lucknow Cantt.-226002

REGISTERED/CIRCULAR

No. Pay/lV/MED/7007/CIR
0/o  the PCDA (CC)

Lucknow
Dated   15/05/2015

To,

THE OFFICER IN CHARGE/COMMANDANT

…………………………..

………………………….

(All Units under jurisdiction  of central command)

SUB: General observations: regarding Medical Bills in respect of Defence Civilians (NON DAO).

During scrutiny/ audit of medical  reimbursement  claim the following  observations are communally observed:-

1.  Scrutiny certificate not found enclosed

2.  Check list, MEO 2004/97/MRCs 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/7007/0rd 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  Dire CGHS (concerned city).

22. The CGHS doctor has not verified  the (ATP) Cash Memos (ADD. DIR. CGHS LUCKNOW Letter N0.3-151/2013-CGHS/LKO  Dot 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.

ADCA (Pay/Med)

Download Principal Controller of Defence Accounts (PDCA) Circular No.Pay/lV/MED/7007/CIR dated 15.05.2015