Section 24 in Employees' State Insurance (Punjab Medical Benefit) Rules, 1953
24. Investigations of prescribing record keeping and certification.
(1)Where it appears to the Director of Health Services after due investigation that there is prima facie case for considering that -(a)(i)an Insurance Medical Practitioner is not dispensing to the insured persons on his list such amount, of simple drugs and dressings as might ordinarily be expected to be reasonably necessary for the adequate treatment of those persons; or(ii)by person of the character or quantity of the drugs or dressings ordered by the Insurance medical Practitioner the charge imposed upon the funds available for the provision of medical benefit is in excess of what was reasonably necessary for the adequate treatment of those persons; or(b)an Insurance Medical Practitioner had failed to carry out his obligations under the terms of service appended to these rules, so far as the obligations involve the recording of clinical date regarding his patients;The Director of Health Services may refer the matter to the Allocation Committee.(2)Where it appears to the Corporation after due investigation that there is a prima facie case for considering that an Insurance medical practitioner has failed to exercise reasonable care in the issue of medical certificate to insured persons on his list or to person for whose treatment he is responsible under these rules, the Corporation may refer the matter to the Allocation Committee.(3)Any reference to the Allocation Committee under the preceding sub-rules shall be accompanied by a statement indicating the matters on which it appears to the Director of Health Services or the Corporation as the case may be that an explanation is required.(4)(a)The Allocation Committee shall furnish the Insurance Medical Practitioner concerned with a copy of the said statement and shall afford him reasonable opportunity of submitting to them a statement in writing and of appearing before and being heard by them.(b)A copy of any such statement by the Insurance Medical Practitioners shall be forwarded to the Director of Health Services or the Corporation as the case may be by the Allocation Committee for their observations and the Director of Health Services or his representative or a representative of the Corporation as the case may be shall be entitled in case of a hearing to attend and be heard by the Allocation Committee.(5)(a)After duly considering the case the Allocation Committee shall draw up a report of their findings on the question whether there has been a failure on the part of the Insurance Medical Practitioner to exercise due care or discretion in any of his proper functions referred to in sub-rules (1) and (2) and, if so, what is the extent and gravity of the failure together with a recommendation as to the action, if any, which should be taken.(b)The Allocation Committee shall forward the report to the Director of Health Services and the Corporation and shall furnish the Insurance Medical Practitioner with a copy of the report.(6)After consideration of the findings and recommendations of the Allocation Committee the Director of Health Services shall, in consultation with the Corporation where the findings relate to investigations of clarification, take action, in accordance with Rule 23(2).
