Veteran Patient Care and Assistance (VPCA) Teams – A Vigilance Mechanism in ECHS

Veteran Patient Care and Assistance (VPCA) Teams – A vigilance Mechanism in ECHS

B/49717-C(VIG)/AG/ECHS

VETERAN PATIENT CARE AND ASSISTANCE (VPCA) TEAMS -A VIGILANCE MECHANISM IN ECHS

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1. Ex Servicemen Contributory Health Scheme (ECHS) is a welfare oriented scheme providing effective healthcare to Ex Servicemen and their dependents. Since in 2003, the scheme has expanded exponentially and has nearly 52 lakh beneficiaries today throughout the length and breadth of the country.

2. There is a need to institute a vigilance framework with a nominated nodal officer at each echelon of the scheme to introduce checks and balances in the system to ensure its efficient and effective functioning . The vigilance frame work so instituted will pay attention to the following aspects with a mechanism to detect, analyse and take corrective and preferably pre-emptive :-

(a) Ensure ECHS benefits are not availed by unauthorized persons.

(b) Check unethical practices I exploitation of ESMs by empanelled facilities.

(c) Monitor referral to empanelled facilities and carry out checks to negate unauthorized treatments/or claims.

Handling of ECHS Issues/Subject/Tasks

3. Tech issues relating to billing, claims and MoA with empanelled hospitals are dealt by Regional Centres of ECHS. All adm issues of Polyclinics are handled by Stn HQ.

4. Regional Centres (RC) ECHS. Comments/ assistance/inv/vigilance on following issues are carried out through RCs:-

(a) MoA with empanelled hospitals therefore complaints regarding empanelled hospitals/Harassment in empanelled hospitals.

(b) Claims/Billing issues of empanelled hospitals.

(c) Indl reimbursement claims received by RC from Polyclinics.

5. Stn HQs. Stn HQs handle the following issues:-

(a) Adm of Polyclinics.

(b) Card making of beneficiaries.

(c) Contractual employment.

(d) Medicine availability through SEMO.

(e) C of I / detailed inv in empanelled hosp or service hosp.

Vigilance Cells

6. A feedback on the satisfactory functioning of Pilot Project at three stations has been obtained. It is now planned to institute the vigilance framework in 14 other major ECHS stations, to include Ambala, Bareilly, Channai, Hyderabad, Jaipur, Jabalpur, Jammu,Kochi, Kolkata, Lucknow, Meerut, Patna, Pune and Ranchi.

7. Composition of Vigilance Cell. The ECHS Vigilance Cell will function under the Stn Cdr and will incorporate a contractual Doctor/serving AMC officer for On-Spot verification of cases of alleged medical negligence/ violation of MoA. It will be composed as under:-

(a) OIC Team. Medical Offr (when accompanying) CMP JCO/NCO.

(b) CMP Team. Two CMP pers (JCO/NCO) in a light vehicle/MC.

(c) Medical Team. One Medical Offr (serving/contractual from ECHS) to be co-opted for all investigations related to hospitals/having examination of medical aspects. Serving offr may be also co-opted under arngs of Stn Cdr.

8. Tasks of Vigilance Cell. While not exhaustive, some of the tasks will be:-

(a) At Polyclinics.

(i) Investigate irregularities I fraudulence by contractual staff.

(ii) Physical verification of ESM and dependents (card and self attested proforma)

(iii) Review adm functioning of Polyclinics when so detailed by Stn I Sub Area I Area HQs on specific instructions

(iv) Surprise physical check of Medicines I Dispensary.

(v) Surprise physical verification of ESM/dependents.

(vi) Check use of ambulance/equipment with Polyclinic.

(vii) Avlb of complaint/Grievance Book and redressal/Comments.

(b) At Regional Centres.

(i) Check BPA verifiers at Regional Centres and any wrong practices by Hospital reps.

(ii) Check process of receipt of bills.

(iii) Ensure process of First in First Out (FIFO) in billing/ as specified by Central Org.

(iv) Monitor hospital representatives visiting for empanelment process.

(v) Security procedure of Regional Centre premises.

(c) At Hospitals/Diagnostic Centres/Labs.

(i) Periodic/Surprise Checks of Empanelled Facilities and patients admitted.

(ii) Physical verification of patients at non-empanelled facilities when so directed.

(iii) Investigate individual cases of fraudulence by beneficiaries .

(iv) Carry out preliminary investigation wrt complaints received at Regional Centre, if so directed by Director Regional Centre. These will be fwd to Stn Cdr being the nodal agency for check.

(v) Assist in medical audits if ordered by Regional Centres / Higher Headquarters .

Investigations and Reporting

9. Investigations. All complaints/reports are to be forwarded to Stn HQ in confidence irrespective of the subject being dealt by any agency. The Stn Cdr will brief the team and allocate the task to them in confidence. No prior info will be made available to vigilance cell members for surprise checks to avoid confidentiality being compromised. Routine and planned checks can be pre-decided.

10. Reporting. Reports will be of two types, viz/Incident/Info Report and Monthly Report. Reports of Vigilance Cell will be forwarded through Stn HQ SO (ECHS) to Area/Sub Area HQ (Dir ECHS/Dir Veteran) to Command HQ (SO ECHS) to Central Org ECHS (Dir C & L). All cases of misuse, fraud and harassment will be reported.

(a) Incident/Info Report. This report will be initiated by the Stn HQ to imdt higher HQ in chain of command within seven days of investigation being completed, with copy to all echelons of Comd till Comd HQ and Central Organisation ECHS (Dir C & L) for prompt action. Report should be passed immediately on telephone depending on gravity of input, to all concerned and followed up by return report so that corrective measures are not delayed. The format is as per Appendix A (in cases where delinquency in respect of serving pers come to notice, it will also be info to HQ Comd (DV) and DV Dte/AG’s Br by Comd (SO ECHS) and Central Organisation ECHS respectively.)

(b) Monthly Report. A monthly report on surprise checks carried out during the month by the Vigilance Team will be forwarded to Central Org ECHS as per format on Appendix B by 20th of next month by the Comd HQ (SO ECHS).

11. Report. The report by the Vigilance Team for various est will be rendered as per u/m formats:-

(a) Empanelled Hospital – Appendix C.

(b) Regional Centre – Appendix D.

(c) Polyclinic – Appendix E.

12. Check list. A suggested check list for the Vigilance Team is at Appendix F.

13. The Stn Cdr will compile the activities of the vigilance team and render a ground report after three months to Central Org ECHS through comd channel with recommendations/inputs to refine the vigilance mechanism.

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