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Tripura High Court · body

2017 DIGILAW 192 (TRI)

Ayushman InfoTech Pvt. Ltd. v. State of Tripura

2017-04-11

S.TALAPATRA

body2017
JUDGMENT & ORDER : Heard Mr. A. Bhowmik, learned counsel appearing for the petitioner as well as Mr. T.D. Majumder, learned G.A. appearing for the respondents. For purpose of clarification, this court has also interacted with Dr. S. Yadab, Director of National Heal Mission who was present in person at the time of hearing. 2. By means of this writ petition, the petitioner has challenged the decision as borne in the letter under No.F.3(5-750)DHS/RSBY/Empanelment/2010 dated 09.03.2017 and has urged this court to direct the respondents No.1, 2 & 3 to award the work of Help Desk under Rashtriya Swasthya Bima Yojna Scheme, the RSBY in short, through open tender calling for expression of interest from all eligible person/firms. The petitioner has alleged in the writ petition that without following any transparent process, the respondent No.3 has engaged the respondent No.4, IFFCO-TOKIO General Insurance Company Ltd. to run the Help Desk of RSBY and requested the respondent No.4 to deploy the manpower in all 88 empanelled Health Government Institutions in Tripura. To provide health security, the Government of India has introduced the RSBY Scheme, a health insurance scheme for the families living below the Poverty Line (BPL) in order to reduce their expenditure on health and to provide access to health. The beneficiaries under the RSBY are entitled to cost of hospitalization to the extent of Rs. 30,000/- per month. The benefit will be available to the defined list of beneficiaries only. For purpose settlement of the claims under the RSBY Scheme the help desk is run in the empanelled health institutions as a transparent procedure is required to be followed. There is no dispute that following the process of tendering, the respondent No.4 has been engaged as the insurer for purpose of the said scheme. The petitioner has not expressed any grievance regarding the nomination of the respondent No.4 through the tender process, but when the petitioner was attracted by the letter dated 09.03.2017, the petitioner was terribly agitated as there was no process of tendering in selecting the respondent No.4 for running the help desk in all 88 empanelled health government institutions under RSBY scheme. The petitioner has averred in the writ petition that since inception of the scheme in Tripura in the year 2009, for running help desk, expression of interest was invited from the registered IT firms based in Tripura and having previous experience in RSBY or in other IT related work under any department to the Government of Tripura. In this regard, the petitioner has relied on a notice inviting Expression of Interest dated 17.05.2014, Annexure-3 to the writ petition, whereby the Director of Health Services, Government of Tripura, Agartala invited expression of interest for running RSBY ‘Help Desk’ in 56(fifty six) hospitals under Health & Family Welfare Department, Government of Tripura. But what has transpired form the letter dated 09.03.2017 that the respondent No.4 has been asked to sign the Memorandum of Understanding to run the help desk with State Nodal Agency (SNA). The respondent No.4 has further been requested to organize training for staffs for health facilities, earmarked for the help desk in two batches. For purpose of reference, the relevant part of the said letter dated 09.03.2017 is extracted hereunder: “Subject: Regarding running of RSBY Help-Desk in all Health Institutions. Sir, The Government of Tripura has in principle accepted your proposal to run the Help-Desk of RSBY as per your letter to the Director of Health Services, Government of Tripura, dated 17th January 2017. However each help desk will also be manned by one staff provided from the respective health facility in addition. Hence you are requested to deploy adequate number of trained manpower as per terms and conditions accepted by you from 25th March 2017 in all 88 empanelled Government Health Institutions of Tripura. Your are requested to sign the MoU to run Help-Desk with State Nodal Agency (SNA). Your are also requested to organize training for staff from our health facilities earmarked for the help desk in two batches on 22.03.2017 & 24.03.2017. This is issued as per approval of U.O No-5635-Pr.Secy (HFW)/17 dated 07.03.2017 of F.3 (5-750) DHS/RSBY/Empanelment/2010.” 3. By filing the reply, the respondents No.1 to 3 have denied the substance of the allegations stating that under the new arrangement for ‘running the Help Desk in RSBY empanelled Government Health Institutions is the responsibility of respective Health Care Provider. This is issued as per approval of U.O No-5635-Pr.Secy (HFW)/17 dated 07.03.2017 of F.3 (5-750) DHS/RSBY/Empanelment/2010.” 3. By filing the reply, the respondents No.1 to 3 have denied the substance of the allegations stating that under the new arrangement for ‘running the Help Desk in RSBY empanelled Government Health Institutions is the responsibility of respective Health Care Provider. It is evident from the Model Tender Documents as prescribed by the Government of India under RSBY for selection of Insurance Company about the responsibility of running the Help Desk by the State Government being Health Care Provider and role of the Insurance Company. An extract of Clause 1.10(b) of the Model Tender Documents is enclosed herein and is marked as Annexure-2 to this affidavit.’ The respondents No.1, 2 & 3 in the reply have further stated that the task of running the help desk was not extended to third party contractor on expiry of the tenure on 31.03.20017 and the same was bestowed on the NMM/Government regular staff, albeit with help and support offered pro-bono by the insurance agency (IFFCO-TOKIO) in place, in consonance with the terms of tender documents for selection of insurance company. The respondents No.1, 2 & 3 have further averred that it is not out of context to submit that when the scheme was first introduced, the awardee insurance company was given the task of running the help desk under agreement without floating any kind of tender for shortage of manpower with the health service provider. The same arrangement was followed in the year 2009, 2010 and till third week of December, 2011. Thus, the respondents No.1, 2 & 3 have contended that the allegation of the petitioner is without foundation. 4. Mr. A. Bhowmik, learned counsel appearing for the petitioner has submitted that this is a hand-in-globe arrangement to avert the process of tendering and to extend undue advantage to the respondent No.4 on extraneous consideration. 5. Mr. T.D. Majumder, learned G.A. appearing for the respondents No.1, 2 & 3 has referred the part of Para-15 of the reply which reads as under: “…….The Insurance Company (Respondent No.4) vide its letter dated 17th January, 2017 has promised to extent Help Desk Support Service free of cost to the respondent No.2, a copy of which is enclosed herein and is marked as Annexure R/7 of this affidavit. The Government has taken decision on such assurance of Insurance Company to run the desks with assistance of the Insurance Company. The Government has considered two issues (i) relating to payment to the Help Desk Agency as a proportion of total claims @ 5.83% of claims settled creates a perverse incentive to inflate the claims which in turn are disputed by the Insurance Company. This has contributed to the huge backlog in unsettled claims by the Insurance Company in the last three years. Significant inconsistencies with regard to the numbers of claims raised by the Help Desk Agency when compared to number of claims raised by the Insurance Company are noticed. It was further noticed that working through the third parties is not beneficial to the beneficiary and as such after expiry of the terms it was not felt expedient to go further with outsource agencies. Copy of the relevant extract of note in file containing decision of the Government is enclosed herein and is marked as Annexure R/8 of this affidavit.” [Emphasis added] For purpose of reference, Clause 7.3 of the agreement between the Government of Tripura and M/S. IFFCO-TOKIO General Insurance Company Ltd. under RSBY is extracted hereunder: “7.3 IT Infrastructure needed for Empanelment in RSBY Both public and private health care providers which fulfill the criteria for empanelment and are selected for empanelment in RSBY by the Insurance Company or their representatives will need to put in place such infrastructure and install such hardware and software as given in Appendix 13.” Clause 7.5 of the said agreement provided as under: “7.5 Additional Responsibilities of the Health Care Providers In addition to providing cashless treatment, the healthcare provider shall: a. Display Clearly their status of being an empanelled provider of Rashtriya Swasthya Bima Yojna in the prescribed format given by State Nodal Agency outside/at their main gate. b. Provide a functional help desk for giving necessary assistance to the RSBY beneficiaries. At least two persons in the hospital will be nominated by the hospital who will be trained in different aspects of RSBY and related hardware and software by the Insurance Company. c. Display a poster near the reception/admission desks along with the other materials supplied by the Insurer for the ease of beneficiaries, Government and Insurer. The template of Empanelled status and poster for reception area will be provided by the State Nodal Agency.” 6. c. Display a poster near the reception/admission desks along with the other materials supplied by the Insurer for the ease of beneficiaries, Government and Insurer. The template of Empanelled status and poster for reception area will be provided by the State Nodal Agency.” 6. From reading of those clauses conjointly, it would transpire that the insurance company shall provide training on different aspect of RSBY relating to hardware and software to the employees nominated and deployed by the empanelled health institutions. In view of such disclosure, this court does not find any merit in this writ petition. Accordingly, the same is dismissed. However, before parting with the records, the respondent No.2, in particular is directed to ensure that under the pretext of imparting training on the different aspects of RSBY Scheme related hardware and software, the insurance company may not influence or control the help desk which is dedicated to aid the beneficiaries under the said scheme, else there would be conflict of interest. The help desk shall be insulated from such influence so as to provide the best and expeditious service to the beneficiaries. There shall be no order as to costs.