Nagaland hospitals have come under scrutiny after the state government took action against 12 empanelled healthcare facilities for alleged violations of norms under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) and the Chief Minister’s Health Insurance Scheme (CMHIS). The matter was disclosed by Nagaland Health and Family Welfare Minister P Paiwang Konyak in the state Assembly on September 1, 2026.
Six hospitals penalised under PM-JAY
According to the minister, six hospitals faced action for violations linked to AB-PMJAY. Another six hospitals were found to have violated norms under CMHIS. The facilities included hospitals located both within and outside Nagaland under the PM-JAY network.
The action followed investigations into alleged irregularities in the implementation of the government-backed health insurance programmes. The hospitals concerned were served show-cause notices and directed to reimburse beneficiaries where unauthorised charges were established. They were subsequently de-empanelled from the schemes.
The government has not publicly identified the 12 facilities. This means beneficiaries cannot independently verify the names of the hospitals involved from the Assembly statement.
The development highlights the state government’s effort to strengthen monitoring of Nagaland hospitals participating in publicly funded health insurance programmes and prevent beneficiaries from being burdened with improper expenses.
Rules on additional charges clarified
The issue came up during supplementary questions from MLA Kuzholuzo Nienu, who sought clarification on whether empanelled hospitals could charge patients beyond the prescribed package rates.
Minister Paiwang said hospitals cannot arbitrarily impose additional charges on beneficiaries. However, expenses for services that fall outside an approved package may be collected from patients if the charges are clearly explained and the patient gives consent.
The clarification is important because PM-JAY and CMHIS are designed to provide cashless treatment to eligible beneficiaries for covered procedures. Unauthorised billing can therefore create a financial burden for families who seek treatment believing that their expenses are covered by the schemes.
The state has also established a grievance redressal mechanism through the Nagaland Health Protection Society (NHPS). Beneficiaries who face unauthorised charges can submit complaints, which are investigated by the authorities. If violations are confirmed, reimbursement and penalties can follow.
Nagaland hospitals remain central to scheme coverage
There are currently 64 hospitals empanelled under AB-PMJAY in Nagaland, according to the minister. The scheme offers health coverage of up to Rs 5 lakh and provides cashless coverage for secondary and tertiary hospitalisation.
Nagaland has also expanded the reach of the programme to around 2.88 lakh households, compared with about 2.59 lakh households covered under the Centre’s 2011 Census-based allocation.
AB-PMJAY covers around 1,970 treatment procedures across 25 specialities. Covered services include hospitalisation and specified day-care procedures such as dialysis, chemotherapy, radiation therapy and minor surgeries.
However, not every medical service falls within the scheme. Outpatient treatment is generally excluded, apart from specified day-care procedures. Cosmetic and aesthetic procedures, dental treatment and fertility-related services such as IVF and surrogacy are also outside the standard PM-JAY coverage.
Earlier concerns over irregularities
The latest action comes after authorities had previously raised concerns about alleged fraud, misuse and financial exploitation involving some empanelled healthcare providers.
In 2025, the NHPS said it had independently examined allegations raised against hospitals and had suspended the empanelment of two hospitals for six months while initiating recovery from two others. The society also said that investigations would continue and that further action would be taken where fraud was established.
The government has simultaneously faced a separate challenge involving delays in insurance claim settlements. In April 2025, NHPS reported that claims worth Rs 178.96 crore had been submitted, of which Rs 147.65 crore had been approved and Rs 99.28 crore had been paid. It said Rs 48.81 crore remained pending at that stage.
These developments underline the need for stronger coordination among hospitals, insurers and government agencies while protecting patients from both financial exploitation and disruption of services.
Beneficiaries urged to know their rights
For patients, the latest action sends a clear message that treatment under PM-JAY and CMHIS must follow approved package rules. Beneficiaries should seek clarification before agreeing to any additional payment and retain bills and other treatment documents if they believe they have been charged improperly.
The government’s action against Nagaland hospitals also indicates that authorities are tightening oversight of empanelled facilities. With thousands of families relying on public health insurance for major medical expenses, effective monitoring will remain essential to ensure that the schemes deliver cashless and affordable healthcare as intended.
As Nagaland expands health insurance coverage, maintaining transparency in billing, prompt grievance handling and strict compliance with scheme guidelines will be critical. The latest penalties are likely to reinforce the message that empanelment comes with clear responsibilities and that violations can result in financial recovery, penalties and removal from the health insurance network.
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