The Employees State Insurance Corporation (ESIC) on July 25, 2024, issued the notification regarding the Strict verification and scrutiny of documents for Super Speciality Treatment (SST) cases.
The following measures are to be strictly implemented:-
• Referring locations must conduct thorough checks, especially for High Cost Treatment cases where the diagnosis date of the disease is after the date of registration in the ESIC system.
• Increase scrutiny of cases to identify any potential nexus between employers and pharmaceutical companies exploiting the system.
• Maintain stringent assessment criteria for approving SST on a case-by-case basis, ensuring only genuine cases receive the benefits.
• Regular audits and monitoring of the cases and referrals to detect and prevent any fraudulent activities.
[Notification No. U-16012/392/2022-SST]
