M/S Maatri Medicity And Orthocare ... vs State Of H.P And Others A/W Connected ... on 25 March, 2026

Author: Jyotsna Rewal Dua

Bench: Jyotsna Rewal Dua

M/s Maatri Medicity and Orthocare Hospital versus State of H.P and others a/w connected matters

CWP No.2080/2026 a/w CWP Nos.2081/2026, 16930, 16939, 16965, 16966, 20980, 8820, 15422,

of 17246, 12248, 12249, 17381, 17401, 17431,16831, 17160 & 19209, 19210/2025, 2484, 2894 & rt 2941 of 2026.

25.03.2026 Present: Mr. Ajay Chandel, Advocate, for the petitioner(s) in all petitions except CWP No. 19209 &

19210/2025 and CWP No.2484/2026.

Mr. Neeraj Sharma, Senior Advocate with Mr. Vidush Chauhan, Advocate for petitioner in CWP No.2484/2026.

Mr. Parav Sharma and Mr. Rupesh Kumar, Advocates for petitioner(s) in CWP No. 19209 &

19210/2025.

Ms. Seema Sharma, Deputy Advocate General,

for respondents No. 1, 3 and 4- State in all the matters.

Mr. Shashi Shirshoo, Central Government Standing Counsel for respondent No.2 in CWP No. 2080/2026.

Mr. Janak Raj, Central Government Standing Counsel, for respondent No.2 in CWP Nos.16930, 16939, 16831, 16965 & 16966/2025.

Ms. Sheetal Vyas, Central Government Standing Counsel, for respondent No.2 in CWP No. 17160/2025.

Mr. Balram Sharma, Deputy Solicitor General of India, for respondent No.2 in CWP No.20980,17381, 17401, 17431/2025, 2484, 2894 & 2941 of 2026.

Mr. Virbahadur Verma, Senior Panel Counsel, for respondent No.1 in CWP No.19209, 19210/2025.

Mr. Anshul Attri, Central Government Standing Counsel, for respondent No.2 in CWP Nos.

8820 & 15422/2025.

Petitioners in all these writ petitions are with the

of same grievances, hence, with the consent of learned counsel

for the parties, all these matters have been connected and rt taken up under the lead case CWP No.2080/2026 (M/s Maatri

Medicity and Orthocare Hospital versus State of H.P and

others).

2. Petitioners in all these writ petitions are duly

empanelled with respondents as health care provides under

the provisions of Ayushman Bharat Pradhan Mantri Jan

Arogya Yojana (PM-JAY) scheme. Their grievances under

these writ petitions pertain to inaction of respondent- State in

not releasing the payments to them towards their duly

approved bills/claims. The gist of petitioners grievances was

noticed as under in the order passed on 25.02.2026:-

"Notice. Mr. Rajat Choudhry, learned Assistant Advocate General, Mr. Shashi Shirshoo, learned Central Government Counsel and Ms. Reeta Thakur, learned Senior Panel Counsel, appear and waive service of notice on behalf of the respective respondents.

2. Heard.

3. Facts:-

3(i). Petitioners are stated to be Hospitals duly empanelled with the respondents as Health Care Providers under the provisions of Ayushman Bharat Pradhan Mantri Jan Arogya Yojna (PM-JNY) Guidelines. Ayushman Bharat has been projected as a flagship scheme of the Government of India launched as per the National Health Policy, 2017 to achieve the vision of universal health coverage. The scheme statedly adopts a continuum of care approach, comprising of:- (a) Health and Wellness Centres; and (b) Pradhan Mantri Jan Arogya Yojna.

.

3(ii). According to the petitioners, the families covered under the aforesaid scheme have been selected by the

Government of India on the basis of Socio-Economic Caste Census, 2011 and Rashtriya Swasthya Bima Yojna.

3(iii). Vide notification dated 29.12.2018, Government of

of Himachal Pradesh also started providing cashless treatment coverage on the analogy of Ayushman Bharat PM-JAY to the left out families under Mukhya Mantri Himachal Health Care Scheme (Himcare). Under this rt notification, the hospitals empanelled under Ayushman Bharat PM-JAY stand automatically empanelled under Himcare. It is further the case of the petitioners that

package rates of Ayushman Bharat have been adopted for Himcare. Under the Himcare Scheme, cashless treatment coverage upto Rs.5 Lakh per year per family is being provided in the empanelled hospitals by following

the guidelines issued for Ayushman Bharat PM-JAY. 3(iv). As per the petitioners, being empanelled Health Care Providers, they are legally bound to provide cashless treatment to the beneficiaries under Ayushman

Bharat PM-JAY as also under the Himcare Scheme. Petitioners continue to be empanelled as such. Petitioners

have provided treatment to the beneficiaries of the aforesaid schemes in cashless manner. In accordance with the guidelines of the scheme, petitioners have submitted their bills/claims to the respondents for settling

the same. All the bills/claims of the petitioners have been approved. The same have also been reflected on the website of respondent No.4. Despite this, respondents have failed to release the payments of duly approved bills/ claims of the petitioners. Non-release of payment towards petitioners' duly approved bills/claims is creating financial hardships for them; That they are adversely affected by the cash-flow due to delay in payment of the approved claims by the respondents.

4. In view of petitioners being empanelled Health Care Providers under the respondents for the schemes in question and despite their bills/claims for having provided cashless treatment to the beneficiaries under both the schemes having been duly approved, the action of the respondents in not releasing the same to the petitioners cannot be justified. The schemes have been designed to holistically address the health care system at primary, secondary and tertiary level for meeting sustainable health goals with underline commitment for 'Leaving no one behind'.
5. In view of the documents placed on record, petitioners have made out a case for grant of interim relief at this stage. Hence, there shall be a direction to the respondents to release the payment to the petitioners

.

towards their duly approved bills/claims by the next date.

Reply be filed within three weeks.

List on 25.03.2026."

3. Respondents No. 1, 3 & 4 (State) have filed reply.

of At the request of learned counsel appearing for respondent

No.2 (Union of India), which is not opposed by learned rt counsel appearing for parties, reply filed by Union of India in

CWP No.8820/2025 (Aastha Multi-specialty Hospital Pvt. Ltd.

versus State of H.P and others) (connected herewith) has

been considered as stand of this respondent in all these

connected writ petitions.

3(i). Respondent-State has clearly admitted that

Himachal Pradesh Swasthya Bima Yojna Society- respondent

No.4 is implementing Ayushman Bharat Pradhan Mantri Jan

Arogya Yojana (AB-PMJAY) and HIMCARE schemes in the

State as per policy guidelines issued by appropriate

governments. According to the respondent State, PMJAY is

centrally sponsored scheme where allocation of fund is made

to the Society in the manner prescribed by National Health

Authority, Ministry of Health & Family Welfare. A copy of the

scheme has been appended as Annexure R-4(1). As per the

scheme, applicable sharing ratio is 90:10 subject to maximum

annual ceiling of ₹1052/- per eligible family. The relevant1052/- per eligible family. The relevant

portion of this scheme is as under:-

1. Maximum Annual Ceiling Limit and Sharing Pattern Ratio A. Maximum Annual Ceiling Limit:
The actual premium and/or treatment cost of AB PM-JAY Beneficiary Families or the maximum ceiling of

.

the estimated annual grant-in-aid/family as decided by Government of India, whichever is less, would be shared

between Central Government and States/Union Territories (Uts) in the ratio as per the directives issued by Ministry of Finance from time to time. This amount shall be subject to amendment as when amended by the directives issued by

of Ministry of Finance in this regard.

The maximum annual grant-in-aid as NHA's Share will be as under:

rt For Norht-Eastern Region, two Himalyan States and 90% of Annual Maximum Ceiling as decided by one Union Territory viz. government of India from

Jammu & Kashmir time to time.

Viz. Rs.946.80 (Rs.1052/- @90%) For States other than North 60% of Annual Maximum

Eastern Region, two Ceiling as decided by Himalayan States and for Government of India from two Union Territories viz. time to time. Puducherry & New Delhi Viz. Rs.631.20

(Rs.1052/@60%) For other Union Territories 100% of Annual Maximum

Ceiling as decided by Government of India from time to time.

Viz. Rs.1052/- (Rs.1052/- @100%)

The ceiling limit shall be applicable irrespective of the implementation mode opted by the State Government/ Union Territory.

B. Sharing Pattern between Central and State Government:

The existing sharing pattern ratio is 60:40 between the Central Government and the States Government/Union Territories for all States and Union Territories other than the seven North-Eastern & two Himalayan States and Union Territories, which have their own Legislatures; and For the seven North-Eastern States, the Union Territory of Jammu and Kashmir and two Himalayan States (viz. Himachal Pradesh and Uttarakahnd), the ratio of sharing between the Central and State Governments will be 90:10; and For Union Territories which do not have their own legislatures, the Central Government may provide up to 100% on a case-to-case basis."
.

It is further the stand of respondents No. 1, 3 & 4-

respondent State that in view of the maximum annual ceiling

and the sharing ratio 90:10 fixed under the scheme, the

of executive agency i.e. Respondent No.4 receives ₹1052/- per eligible family. The relevant55.00

crores in a year i.e. ₹1052/- per eligible family. The relevant49.71 crores as Central Share and rt ₹1052/- per eligible family. The relevant5.52 crores as State share.

3(ii). Reply filed by Union of India in Aastha Multi-

specialty Hospital Pvt. Ltd. versus State of H.P and others, is

to the effect, which is not disputed by respondent-State that

Union of India has released its entire share in terms of this

scheme to the executive agency i.e. Respondent No.4.

3(iii). According to respondent No.4, it has received

claims above ₹1052/- per eligible family. The relevant55.00 crores from the empanelled hospitals

including the petitioners, which over the last two financial

years have accumulated to more than ₹1052/- per eligible family. The relevant201.16 crores.

4. No questions of facts have been raised by

respondent-State in reply to the writ petitions. The only reason

for not releasing due admissible and approved claims of the

petitioners (empanelled hospitals under the aforesaid

scheme) is on account of availability of funds. According to the

respondents "as and when funds shall be received from

appropriate governments, the pendency of eligible claims shall

be cleared in accordance with applicable rules and scheme

guidelines."

Following tabulation gives the gist of petitioners

grievance in respect of their pending claims:-
.

Sr. CASE TITLE PENDING PENDING CLAIM CLAIM No. No. OF THE CLAIM AT THE CLAIM AT RELEASE RELEASED CASE TIME OF THE TIME D DURING DURING

FILING OF THE OF FILING PENDENC PENDENCY PETITION OF THE Y OF THE OF THE under PETITION PETITION PETITION AYUSHMAN under under under BHARAT HIMCARE AYUSHM HIMCARE

of Scheme Scheme AN Scheme BHARAT (Including Scheme TDS) (Including TDS)

1.

rt CWP- M/s 8820/ Aastha Multispe ciality Rs.7,19,000 Rs.

61,01,000 Rs.2,17,30

Rs.58,60,100

Hospital Vs State

2. CWP- M/s -------------------- Rs. --------------- Rs.

15097 Surya 3,16,13,123 ----------- 2,92,79,798 /25 Hospital Vs State

3. CWP- Bhardwa Rs. 41,48,543 Rs. No amount Rs. 22,07,600 15422 j 70,86,100 received /25 Multispe

ciality Hospital Vs State

4. CWP- Dev Rs. 4,37,600 Rs. No amount Rs. 50,00,000 16831 Bhoomi 97,69,000 received Rs. 30,11,900 /25 Eye Hospital vs State

5. CWP- Apex Rs. 2,36,225 Rs. Rs. 81,625 Rs. 13,03,370 16930 Multispe 26,52,000 /25 cialty Hospital and Heart Care Centre vs State

6. CWP- M/s City Rs.1,34,30,819 Rs. Rs. Rs.

16939 Care 2,47,20,645 32,35,350 1,31,79,812 /25 Multispe ciality Hospital vs State

7. CWP- Advance Rs. 3,13,900 Rs. Rs. Rs. 15,09,737 16935 d 31,51,204 1,52,800 /25 Cardiac Cath Lab vs State

8. CWP- Capt. Rs. 46,38,913 Rs. Rs. Rs. 67,01,898 16966 Saurabh 1,23,35,375 11,94,848 /25 Kalia Memorial Kaydee Hospital vs State

9. CWP- Shri Rs. 43,30,090 Rs.46,52,900 No amount Rs. 37,00,000 17160 Krishna received /25 Children Hospital

.

vs State

10. CWP- Shivam Rs.1,83,69,310 Rs.2,36,65,7 No amount Rs. 69,54,400

17246 Orthocar 00 received /25 e vs State

11. CWP- Navneet Rs. 22,08,726 Rs. Rs. Rs. 20,48,852 17248 Urology 67,95,493 18,92,701

of /25 and General Surgery Hospital vs State

12.
              rt
           CWP- M/s
           17249 Anandraj
           /25   Malik
                             Rs. 26,76,660           Rs.
                                                  56,21,300
                                                               No amount Rs. 16,84,000
                                                                received

                 Hospital

                 vs State
     13.   CWP- M/s Dev Rs. 2,15,88,394              Rs.          Rs.      Rs. 58,79,117
           17381 Bhoomi                          1,18,76,859   23,56,291
           /25   Advaita
                 Heart
                 Institute


                 vs State
     14.   CWP- City         Rs. 1,55,78,884 Rs.4,19,31,2 No amount            Rs.
           17401 Heart                            17       received        1,20,01,566
           /25   Supersp




                 eciality
                 Hospital
                 vs State
15. CWP- M/s Shri Rs. 1,81,86,019 Rs.3,28,02,8 No amount Rs. 95,99,802 17431 Harihar 97 received /25 Hospital and Researc

h Centre vs State

16. CWP- M/s Shri Rs. 7,70,900 Rs. No amount Rs. 23,26,250 20980 Balmuka 77,57,900 received /25 nd Apex Hospital vs State

17. CWP- M/s Rs. 60,86,327 Rs. No amount Rs.50,34,000 2080/ Maatri 88,80,000 received 26 Medicity and Orthocar e Hospital vs State

18. CWP- M/s Dr. Rs. 65,79,511 Rs. No amount Rs. 50,13,000 2081/ Neena 1,58,46,689 received 26 Pahwa Maternity Home vs State

19. CWP- M/s Life Rs. 44,40,125 Rs. No amount Rs. 2,20,410 2894/ Line 76,59,600 received 26 Care Hospital vs State

20. CWP- M/s Rs. 45,02,475 Rs. No amount Rs. 1,81,000 2941/ Bhambla 50,26,500 received 26 Multispe ciality Hospital

.

vs State

21. CWP- Sai Rs.69,32,825 1,90,58,475 No amount Rs. 50,39,000

2484/ Sanjeev received.

2026 ani vs State

22. 19209 Bhanoo Rs. Not Rs.13,29,796 /2025 Hospital Rs.13,56,773 36,96,025 received

of Pvt. Ltd.

vs Union of India

23. 19210 Bhanoo Rs.37,11,700 Rs. Not Rs.8,48,566 /2025 Hospital rt 51,78,700 received Pvt. Ltd.

vs Union of India

Above huge pending claims of the petitioners are in

respect of services already rendered by them in terms of the

schemes. Furthermore the claims have been duly examined

and approved yet these have not been released in entirety.

The services being rendered by the petitioners are continuous

in nature. The claims shall keep on increasing with every

passing day with further patient care. The respondent-State

being a welfare entity committed to constitutional principles

has fundamental obligation to honour its commitment and

cannot deny legitimate claims compelling the petitioners to

seek judicial intervention for what is rightfully due to them. In

the backdrop of the policy where the State entered into

contracts and the work is completed about which there is no

dispute on facts and the bills are approved, State cannot

withhold the payments of approved bills of the petitioners. The

release of petitioners' rightful dues is akin to right to property

protected under Article 300 (A) of the Constitution. As a model

employer as a model welfare entity respondent-State is duty

bound to uphold its bargain and fulfill its payment obligations

.

to ensure fairness, accountability and trust in pubic dealings.

More so, when the aforesaid schemes are aimed in

furtherance of right to life for sustainable health goals of

of general public for covering the targeted areas under the health

schemes. In case the petitioners are not paid their duly rt approved bills, they would be adversely affected by cash flow,

which in turn would affect the running of the scheme,

ultimately creating negative impact upon the health care

system i.e. goal under the scheme.

For the foregoing reasons, respondent-State is

directed to release all pending approved bills of the petitioners

by making upto date full and final payments to them within

two weeks from today, failing which, the respondents shall

remain present in the Court on the next date when appropriate

order in accordance with law shall be passed.

List on 10.04.2026.

Jyotsna Rewal Dua Judge March, 25, 2026 (yogesh)