In a long investigation Operation White Coat spanning three mega-cities of Delhi-NCR, Mumbai and Bangalore and covering 20 major private multi-specialty hospitals, Cobrapost has unearthed a racket of referrals in which these hospitals offer commission ranging between 10 and 30 per cent to doctors and smaller hospitals or nursing homes.
Undertaken by Cobrapost Special Correspondent Umesh Patil, the investigation exposes almost all marquee names among private health care providers, namely, Fortis Hospital (with a branch each in Mumbai and Bangalore), JP Hospital, Metro Hospital in Noida; Yashoda Hospital and Columbia Asia Hospital (with a branch in Bangalore) in Ghaziabad; MAX Hospitals (in Saket and Patparganj), Apollo Hospital (with a branch in Bangalore), BLK Super Speciality Hospital, all in Delhi; Nanavati Super Speciality Hospital, Hiranandani Hospital, Asian Heart Institute, Seven Hills Hospital and Jaslok Hospital, all in Mumbai; and Narayana Hrudayalaya College of Nursing and Mallya Hospital both in Bangalore.
In the course of this undercover investigation, Cobrapost Special Correspondent interviewed marketing officials, not less than the rank of assistant managers, of these hospitals who without exception candidly admitted on camera to offering handsome rewards to doctors, and smaller hospitals, who send their patients to these super-specialty hospitals for serious ailments.
These confessions can be summed as follows:
- To make more business out of patients’ miseries, all these hospitals offer handsome commissions to individual doctors, nursing homes and smaller hospitals, which cannot handle serious ailments, on all referrals.
- Each hospital has an elaborate process for such referrals and pay-offs thereof.
- Commissions to individual doctors are paid out to them as consultation fee.
- In addition to regular cuts, some of these hospitals give such doctors expensive gifts.
- All these hospitals have a well-oiled network of doctors and small nursing homes and hospitals, to help them generate a steady business out of patients’ needs for specialized treatment.
- Well, they also know that this is a malpractice under the MCI guidelines, yet they do not blink an eye while indulging in it.
It should be kept in mind that the MCI guidelines specifically prohibit the disbursement of commission by hospitals for patients referred to them. The MCI Code of Ethics Regulations, 2002 Chapter 6 Unethical Acts are as follows:
6.4 Rebates and Commission
6.4.1 A physician shall not give, solicit, or receive nor shall he offer to give solicit or receive, any gift, gratuity, commission or bonus in consideration of or return for the referring, recommending or procuring of any patient for medical, surgical or other treatment. A physician shall not directly or indirectly, participate in or be a party to act of division, transference, assignment, subordination, rebating, splitting or refunding of any fee for medical, surgical or other treatment.
Their sole motive is to soar up their profits by hook or by crook, and in the process they dole out crores of rupees in referral cuts, apparently at the expense of their gullible customers who happen to be patients and need care. For instance, JP Hospital Deputy Manager (Sales and Marketing) Amit Kumar Bandopadhyay and Sr. Manager D. K. Bhardwaj both tell us their hospital gives a 10 per cent cut on patient referrals and has provisions for it.
Pranav Sinha, Corporate Communications Head of Metro Hospital and his colleague Assistant Manager (Corporate Affairs) Belal Ahmed educate us on how much commission his hospital pays out for referrals for procedures like stent implant, angiography, valve replacement, hip replacement, radiotherapy and chemotherapy, among others.
Sr. Manager Sumit of Max Hospital, Saket says, “10 per cent hota hai aur wo excluding … (We give 10 per cent [cut] and that is excluding …),” Sumit informs us but refuses to give us the rate list: “Yaar wo main officially to de nahi sakta (I cannot give you that list officially).” But there is one condition. One will be eligible for this referral cut only when he is informed three hours before a patient is admitted. According to Assistant Manager Mustafa, the hospital has about 400 doctors who provide it referrals and if what Mustafa says is true the hospital pays about Rs. 20–25 lakh every month in referral cuts.
Deputy Marketing Manager Ashish at Max’s Patparganj Unit says: “10 per cent milega lekin excluding medicine aur wo bhi agar ek patient hoga …uspe capping hogi 30,000 ki (You will get a 10 per cent cut, excluding medicine [bill] if there is one patient … but there is a capping of Rs. 30,000).” According to Ashish, even doctor who conducts a surgery gives payout for such referrals.
Sr. Manager Ram Naresh Bhagat of Indraprastha Apollo Hospital, Delhi tells us that we can get 10 per cent cut on referrals for almost all medical procedures, and the payments are made by cheque favouring only those with whom the hospital will have entered into an agreement. Apollo also receives patients from abroad, and if you refer a foreign patient to them, you can make a neat cut of 15 per cent.
Next, we call on Vinay, Senior Manager with the BLK Super Speciality Hospital on Pusa Road in Delhi, to check if our tip-off had any substance. It does not take much time to get Vinay talking, who tells us we can get a 12 per cent of referral cut on total bill, excluding medicines.
Situated on NH 24 in Ghaziabad, Columbia Asia Hospital’s Marketing Manager Satyanarayana does not have any qualms while telling us he is flexible on referral cut: “Bada case hai aap bolo total bill ka aap 10 per cent bolte hain … nahi aisa nahi waisa chahiye … humko 40 chahiye 50 chahiye meri taraf se main toh flexible hoon”
Deputy Manager Nishant Chauhan of Fortis Hospital, Noida spills it all for us: “Bhai JP de sakta hai dekho competition toh sabka hai humara toh yahi rahega 10 per cent hum log dete hain wahi humara rahega agreement (Brother, JP [Hospital] might offer you more. No doubt, there is competition but we give 10 per cent and this will be our agreement).” At this hospital, according to Chauhan, every procedure package carries a fixed referral cut, which ranges from Rs. 10,000 to Rs. 15,000.
When we meet Nagender, Senior Marketing Manager of Yashoda Hospital, Ghaziabad, he tells us we will get a referral cut of 10 per cent on the bill raised excluding medicine expenses. Now, what Nagender says reveals is the demonic face of the medical practitioners at its ugliest: “Business revenue se related hai saari cheejein samajh rahe ho kisi ko knee replacement bol diya doctor kahega karao karoa … zaroorat nahi hai aise hi nakal lo time … ye toh hai ab ye batao doctor nahi karega to uski degree fail hai na kaahe ko aaya wo parh-likh kar itna … toh jis company ne ye jo knee replacement ke wo bekar hain unki manufacturing bekar hai unke bhi … khali … toh toh chain bani hui hai poori jo stent supply karte hain unke bhi aise hi …
Bhagat Singh, Manager, Dr. L.H. Hiranandani Hospital in Powai, Mumbai, comes up with his offer of referral cut on knee replacement: “Usmein aapko 15 se upar hi milega matlab main toh bol raha hoon 15 ke upar (You will get a cut of Rs. 15000 on that. I am telling you).” In case the patient has to get both his knees replaced, the cut will be almost double. “Wo mil jayega abhi start karo (You will get that. You just start it),” Singh assures. Then he also reveals how much we will get in other procedures.
Senior Manager at Fortis Hiranandani Hospital, Mumbai Shubhendu Bhattacharya advises us to bring surgical cases: “Main aapko bata deta hoon agar surgical case rahega toh theek rahega (I should tell you it is better if you refer surgical cases).” The reason is they offer 15 per cent referral cut in such cases. Similar is the case with procedures such as valve replacement. Bhattacharya rattles off rates of referral cuts for various procedures.
Claiming to be the best in heart care, Mumbai’s Asian Heart Institute Hospital’s Assistant Manager Milind Mehta told that the hospital has more than 100 doctors on its panel who send in patients. However, the hospital offers referral cut of 2–3 per cent only.
Assistant General Manager Shiv Kumar and then Senior Manager Virendra of Seven Hills Hospital, Mumbai says that hospital has a tie-up with about 1500 doctors and 250 smaller hospitals to help keep its cash registers always ringing, and there is 10 per cent referral cut for all to be collected.
Nanavati Super Speciality Hospital, Mumbai has a separate referral team to deal with all kinds of referrals. Arvind Maurya, Head of the Referral Team, tells us: “Hospital ka aapka jo tie-up hai hospital se tie-up kar sakte hain hum log jo bhi patient ayega uspe sirf durgs disposable aur implant minus karke 10 per cent mil jayega aapko
The famed Jaslok Hospital located in Pedar Road in Mumbai is no exception to this referral racket. Markting Manager Subodh tells us that before referring a patient to Jaslok, they need to be informed. Here, one gets 10 per cent cut on investigation bills apart from the regular medical procedure employed for an IPD patient.
Fortis Hospital, Bangalore’s Assistant Manager Pravez Sajjad tells us we have approached the right person as he deals with referral cases. He explains: “See it [sic] everything depends upon the bill … referral cut jo hota hai … normally we make it on 5% on the total bill.” The hospital has tie-ups with medical practitioners and small hospitals and nursing homes.
When Cobrapost Correspondent asks Nitej Senior Manager, Apollo Hospital, Bangalore in what mode his referral cut will be paid and in how many days, Neetej enlightens in these no uncertain words: “NEFT … we have […] ten patients has to refer.”
Columbia Asia Hospital, Bangalore Marketing Manager, Kumar Hiramat has a fabulous terminology to define this kind of arrangements of mutual benefit: business to business tie-up. Kumar explains how we should move about the deal: “Monthly jaise aap patient bhejte hain referral letter ke saath bhejna aur idhar admission hoga discharge hone ke baad hum log bill forward kar denge usko apko ek invoice daal kar bhejna hai itna bill hua hai humara business to business agreement agreed percentage
Our conversation with Marketing Manager Anthony Sagayaraj of Narayana Hridaylaya Hospital in Banglore can be summed up in these words in which he explains how we will be given our referral cut of 10 per cent.
- Soma Sekhar, Business Development Manager of Mallya Hospital in Banglore reveals all about this shady aspect of this business. Listen to what he says: “See if the patient get admitted 1lakh may be the approximately the patients bill out of which some 15 or 20 thousand the upper charges including … and everything procedure approximately 20,000 in that 20 he is going to share the … three specialty I will take the responsibility … oncology, cardiology and hip replacement.”
Flouting all ethics of a noble profession and the MCI guidelines that govern the conduct of this profession across India, such a malpractice is symptomatic of the rot that has set in with the government having unleashed corporate greed on a human need as basic and fundamental as health care. We all know doctors who ask their patients to undergo a myriad of tests, not always necessary, to arrive at a diagnosis, get a handsome cut ranging anything from 20 per cent to 40 per cent on every referral they make to various pathology labs across the country. Now, if the professional in white coat, who you trust with your life and limb, refers you to a super-specialty hospital, his intentions may not be as pious as you may think.
It was high time government agencies and MCI took note of such malpractices.