The West Bengal Health Department has excluded two third-party administrators (TPAs) from the tender process for Ayushman Bharat and the Mukhyamantri Swasthya Bima Yojana after citing serious irregularity complaints and alleged non-compliance with government scheme rules, according to a report by Anandabazar.
The two companies named in the department’s directive are Medi Assist Health Insurance and Volo Health Insurent TPA Private Limited. Both were among eight companies that participated in the tender process to provide third-party administration or implementation support agency services for the two government-backed health insurance schemes.
The department’s action follows repeated complaints about alleged coordination between some nursing homes and intermediaries involved in processing insurance claims. The reported allegations include the preparation of false bills and the use of incorrect treatment categories to increase the amount claimed from public schemes.
A Health Department official cited in the report described one case involving a nursing home in Burdwan. According to the official, a patient who was supposed to be admitted under a surgical package was shown as receiving treatment under a medical management package. The latter category reportedly did not have a fixed ceiling on treatment costs, while surgical packages had prescribed limits. The bill in the case was allegedly increased from Rs 40,000 to Rs 90,000.
The same official said that 14 such instances had been identified at one nursing home in Burdwan. The report also cited discrepancies in insurance records, including cases in which spinal surgery was allegedly attributed to an orthopaedic surgeon rather than a neurosurgeon. These claims have been reported as examples of the irregularities under examination and are not presented as findings against all hospitals or nursing homes.
TPAs play a significant role in examining claims and approving insurance amounts. The Health Department had earlier issued guidelines aimed at preventing irregularities, but the report said that no TPA had previously been removed from the process despite complaints. The latest tender decision therefore represents a change in how the state is screening agencies responsible for managing claims under its public health insurance framework.
The Association of Private Hospital and Nursing Home, a newly formed organisation, welcomed the department’s decision. Its secretary, Rajib Pandey, said private hospitals and nursing homes had repeatedly informed the Health Department about alleged unethical practices involving some TPAs. He said the organisation was pleased that agencies facing complaints had been excluded.
The reported action comes as the state seeks to rely more heavily on Ayushman Bharat and the Mukhyamantri Swasthya Bima Yojana for healthcare access. The schemes were launched together in West Bengal in August, while the Swasthya Sathi programme continues to operate. The report said the government intends to use the newer schemes to extend health services to residents, even as questions remain about the ability of insurance-based systems to complement public hospitals and manage patient demand.
Senior Health Department officials have reportedly avoided expressing immediate satisfaction over the decision, while Health Minister Sharadwata Mukhopadhyay declined to comment. The next step is the continuation of the tender process among the remaining eligible agencies and the department’s implementation of its revised oversight arrangements.
