What Is The Legal Procedure For Filing A Complaint Against A Fraudulent Hospital?

When a hospital engages in fraudulent practices, such as overbilling, misrepresentation of treatments, or unnecessary medical procedures, patients have the right to file a legal complaint. In India, there are specific procedures available for individuals to seek justice and compensation through both legal channels and consumer protection laws.

Legal Procedure for Filing a Complaint Against a Fraudulent Hospital:

Collect Evidence:

Before filing a complaint, gather all relevant documents, such as medical records, bills, receipts, prescriptions, and any communication with the hospital. This evidence will be essential to support your claim of fraud.

Take photographs or videos of any discrepancies, if possible, and maintain a clear record of the events leading to the complaint.

Contact the Hospital or Healthcare Provider:

If possible, first approach the hospital management or customer service to report the fraudulent activity. Many hospitals have a grievance redressal mechanism in place that might resolve the issue without the need for legal action.

Ensure to document any communication you have with the hospital for future reference.

File a Complaint with the Consumer Forum:

If the issue remains unresolved, you can file a complaint under the Consumer Protection Act, 2019. Hospitals providing medical services are considered service providers under this Act.

You can file your complaint with the District Consumer Disputes Redressal Forum if the value of the claim is up to Rs. 1 crore. For higher claims, you may approach the State Consumer Disputes Redressal Commission or the National Consumer Disputes Redressal Commission (NCDRC).

The complaint can be filed online or in person, and the hospital will be required to respond to the complaint in a given timeframe.

Register a Police Complaint:

If the fraud is severe or involves criminal activity (e.g., overbilling, false documentation), you can file a First Information Report (FIR) with the local police.

The police will investigate the case and, if necessary, file charges under relevant sections of the Indian Penal Code (IPC), such as Section 420 (Cheating), Section 409 (Criminal Breach of Trust), or other applicable fraud-related offenses.

File a Medical Negligence Complaint (if applicable):

If the fraud involves medical malpractice or negligence (e.g., performing unnecessary surgeries or procedures), a complaint can also be filed with the Medical Council of India (MCI) or the State Medical Council.

Medical boards review these complaints and determine whether there was medical negligence or violation of professional ethics by the hospital or medical practitioners.

Approach the Health Department or Regulatory Authorities:

If the hospital’s actions breach health regulations or medical ethics, you can approach the Ministry of Health and Family Welfare or the State Health Department. These authorities may take action or recommend an investigation.

Seek Legal Advice and Representation:

If the fraud is complicated or involves significant financial loss, it may be beneficial to consult a lawyer specializing in consumer rights, medical malpractice, or fraud. A lawyer can help guide you through the legal process, draft legal notices, and represent you in court if necessary.

Legal professionals can also assist in preparing the necessary documents and evidence to present to the consumer forum or courts.

File a Civil Suit (If Needed):

If you are seeking compensation for financial loss due to fraudulent practices, you can file a civil suit in a local court under Section 2 of the Consumer Protection Act for unfair trade practices, breach of contract, or fraud.

You can claim compensation for damages, medical costs, mental anguish, and other related expenses in your suit.

Legal Actions and Protections:

Compensation and Redress:

The consumer forums, as well as courts, can order compensation for any financial loss, pain, and suffering caused by the fraudulent actions of the hospital.

The National Consumer Disputes Redressal Commission (NCDRC) has the authority to pass binding orders for compensation and penalty.

Penalties for Fraudulent Practices:

Hospitals found guilty of fraudulent practices may face heavy fines, suspension of licenses, and criminal charges depending on the severity of the offense.

The government or regulatory bodies may revoke the hospital's license or take action against healthcare professionals involved in the fraud.

Example:

Suppose a hospital charges a patient for a surgery that was never performed, and the bill includes inflated charges for services that were never provided. The steps to file a complaint would be:

• Gather medical records, bills, and correspondence that show the fraud (e.g., absence of surgery or incorrect charges).
• First, approach the hospital’s grievance cell or management to resolve the issue.
• If unresolved, file a complaint with the District Consumer Forum or NCDRC, depending on the claim amount.
• Simultaneously, if applicable, file an FIR with the police under cheating and criminal breach of trust.
• Consult a lawyer to help navigate the legal system and ensure you get appropriate compensation for the fraudulent activities.