Coimbatore: Four private labs barred from reimbursing cost of tests

COIMBATORE: The state government has banned four private laboratories in the district from collecting reimbursement from the Tamil Nadu Comprehensive Health Insurance Scheme for Covid-19 tests they run in Coimbatore.
The four labs Microbiological Laboratories, Orbito Asia, Bioline and Krishna Laboratory will also not be able to run samples collected by public health authorities or Coimbatore Corporation. This move comes after an insurance company, United India Insurance, found out that the said four labs were suddenly testing an extraordinary number of samples, some of them suspected to be unnecessary.
However, in a letter accessed by TOI, Tamil Nadu Health Systems project director, Ajay Yadav, on Monday clarified to United Insurance Company Limited that the above mentioned four labs can continue to claim reimbursements for tests run for CMCHIS card holders and non-card holders from all adjacent districts, except Coimbatore. This is keeping in view “the heavy load of samples and lack of sufficient capacities in neighbouring districts,” his letter said.
Ajay Yadhav, director, TNHSP, said “we have not debarred any laboratory from conducting tests, and don’t have the authority to do so. The labs are still allowed to run government collected samples from other districts, if they follow ICMR protocols strictly. The TNHSP core committee has asked them to run samples from other districts, because they don’t have adequate facilities to test so many samples. But Coimbatore in its government hospitals has enough facilities to run their own samples,” he said.
On July 3, TNHSP informed United India insurance that the four private laboratories have been debarred from conducting RT-PCR testing for CMCHIS beneficiaries and non-CMCHIS beneficiaries, and that payments were not to be released pending an enquiry. The letter claimed that the labs have “submitted an unusually high number of RT-PCR cases under CMCHIS”. While Orbito Asia ran 29,200 samples, Bioline laboratory ran 16,663 samples, Microbiological laboratory ran 16,277 samples and Krishna Laboratory ran 6,838 samples, totalling 69,000 samples approximately.
However, on Monday, TNHSP said the labs could run tests for individuals who approach them in Coimbatore, but cannot claim insurance reimbursement under CMCHIS for the same. They can claim the reimbursement for tests sent to them from “adjacent districts”. “The labs have to submit details or originating district of test sample, public health authority who referred the sample, % of entries made in ICMR portal and rate of positivity”.
Yadhav said they have not found any discrepancies so far, but are conducting enquiries to verify the numbers. “This is a routine procedure that we do even for hospitals and other procedures regularly,” he said.
While Orbito Asia refused to comment, Microbiological laboratory’s spokesperson clarified that they have clear documents for every government-sent sample they have tested so far and submitted for reimbursements.
“The number of samples has increased in the last one month, because the number of cases has increased leading to the government authorities collecting more samples as part of contact tracing. They are giving us samples, to reduce their sample running overload. We run tests on 180 to 450 samples a day and not just from Coimbatore, but from Namakkal, Trichy, Tirupur and even Nilgiris. We are willing to face any enquiry. Of the 17,000 samples we have run for the government, we are yet to receive reimbursements for 9,000 of them,” she said.
Meanwhile, the public health authorities in Coimbatore who now have to manage without private laboratories to test their samples, said they can manage with CMCH which can now run 1,500 samples a day and ESI which can run 200 to 250 samples a day. “ There will be slight backlog of cases everyday, because we collect more than 2000 samples a day, but we will manage,” said deputy director Dr Ramesh.