In aN administrative collapse, Chhattisgarh’s ambitious Shaheed Veer Narayan Singh Ayushman Swasthya Yojana (SVNSASY) – an allied scheme under the Ayushman Bharat umbrella – has come to a near standstill with over Rs 800 crore in hospital claims pending since February 2025. Official documents accessed by ‘The Hitavada’ reveal that no claim has been processed for nearly five months, leaving over 1,600 hospitals and nearly 81 lakh enrolled families in limbo. The paralysis stems from the expiry of the state’s Third Party Administrator (TPA) contract on March 30, 2025, without any new agency being appointed.

 

The State Nodal Agency (SNA), which is tasked with overseeing the scheme under the Directorate of Health Services, had floated a fresh tender in May. But due to contentious and rigid tender conditions – particularly the clause mandating claim processing offices be set up within the SNA’s own premises –no bidder showed interest within the stipulated deadline. Despite this, the tender was neither cancelled nor amended. Instead, it was reissued under identical terms, raising questions of procedural fairness and transparency. While the SNA insists on maintaining “oversight”, hospitals argue that this opens the door to bureaucratic interference. “Allowing the nodal agency to physically host the claims team risks manipulation and compromises adjudicative neutrality,” said a representative of one of the state’s largest private hospital chains, requesting anonymity.

 

Making matters worse, it has emerged that for over a year, the SNA employed rural bond MBBS doctors-originally meant for compulsory service in remote primary health centres-to scrutinise and process complex claims of tertiary and super-specialty procedures. These generalist doctors, with no training in medical audit or insurance, were allegedly given informal instructions to reject or delay large-ticket claims. Their output, sources confirm, led to an “artificial suppression” of the government’s liability in the scheme, allowing the fiscal books to appear less burdened than they truly are. “This is a disturbing diversion of medical manpower,” said a retired public health expert, “and a violation of the spirit of rural health bond policy. You can’t put untrained MBBS doctors in charge of evaluating cardiac stents, neurosurgery or oncology protocols –they’re simply not qualified.” The fallout of this systemic clog is now painfully visible.

 

Hospitals that offered treatment under Ayushman packages are returning patients or charging them upfront, in violation of the scheme’s cashless mandate. In multiple districts, verified cases have emerged where patients were forced to abandon treatment midway because empanelled hospitals refused further admissions without confirmed reimbursement. A senior administrative official, speaking on background, admitted that “the state owes roughly Rs 800 crore to empanelled hospitals, and this could spiral if claim processing isn’t restored soon.” Internal correspondence also reveals that even the Grievance Redressal Committees (GRCs) set up under the scheme have failed to resolve disputes, as their orders are routinely ignored or kept pending by theSNA. Adding further complications, the June 23 tender opening attracted only two bids, falling short of the minimum required participants for financial evaluation. The state has now deferred the process to June 28, again under pressure and without resolving the clause that bidders consider draconian.

 

According to figures from Annexure-1 of the official tender documents, 16.64 lakh claims worth Rs2,336.83 crore were processed last fiscal year under AB-PMJAY SVSASY. The current freeze puts both the scheme’s integrity and patient trust at severe risk, particularly in a state like Chhattisgarh, where nearly 81 lakh poor and vulnerable families depend on this programme for critical hospitalisation coverage. This includes families from tribal, labour and socially deprived categories as defined in the SECC database, for whom private healthcare remains otherwise unaffordable. Verma slams BJP for halting SVNSASY claims, calls it commission-driven sabotage: Calling it a deliberate malpractice by the BJP-led state government, State Congress Senior Spokesman Surendra Verma alleged that claim processing under the SVNSASY has been arbitrarily halted since February 2025 by the SNA. With the TPA contract expiring on March 30, 2025, no new agency has been appointed, leading to pending dues for private hospitals and, in several cases, forced closures.

 

Verma said many hospitals have begun refusing treatment to Ayushman cardholders due to non-payment. He further claimed that the government’s insistence on a hefty commission has stalled consensus in the tendering process. Although tenders were invited, not a single company agreed to the restrictive conditions – particularly the clause mandating claim processing from within the Health Directorate itself. Despite this, the tender hasn’t been cancelled or amended. “Insisting on the same flawed terms raises serious questions about transparency and neutrality,” Verma concluded.