ESIC Deputy Medical Commissioner (SST) issues direction to implement various measures to safeguard and mitigate fraudulent activities pertaining to Super Speciality Treatment

Posted On - 14 September, 2024 • By - King Stubb & Kasiva

Following the directions of the High Court of Delhi ESIC Deputy Medical Commissioner (SST), ESIC has issued following measures vide File No. U-16012/392/2022-SST dated 25th July 2024 to be implemented in all ESIC hospitals and ESI Medical Colleges through regional directors of all states:

  1. Conduct thorough checks, especially in respect of high cost treatment cases where diagnosis date of the decease is after the date of registration in the ESIC system.
  2. Increase scrutiny of cases to identify any potential nexus between the employers and pharmaceutical companies exploiting the system.
  3. Maintain stringent assessment criteria for approving SST on a case-by-case basis, ensuring only genuine cases receive benefits.
  4. Regular audits and monitoring of the cases and referrals to detect and prevent fraudulent activities.
  5. Regional directors are requested to conduct detailed document verification for all new cases.