The Employees' State Insurance Corporation (ESIC) on June 25, 2026, issued the Standard Operating Procedure (SOP) & Checklist for Surprise Visits to Empanelled Hospitals.
The following has been stated:
• It has issued a Standard Operating Procedure (SOP) and Inspection Checklist for conducting surprise visits to empanelled hospitals to ensure uniformity, transparency, and timely decision-making across ESIC/ESIS institutions. The SOP aims to assess the quality and availability of medical services, compliance with ESIC/CGHS empanelment norms, infrastructure, manpower, equipment, adherence to treatment protocols, patient care standards, and detect fraud, overbilling, denial of services, or misuse of empanelment. Surprise inspections will apply to empanelled hospitals, diagnostic centres, and specialty centres for routine monitoring, complaint verification, quality assessment, infrastructure verification, treatment claim validation, post-empanelment compliance, and renewal reviews.
• Inspection teams of 2–4 members, nominated by the Zonal Medical Commissioner (ZMC), must conduct at least two surprise inspections every month, with a focus on ICU cases, billing practices, specialist availability, referral compliance, and fraud detection. Inspectors are required to verify patient identity and eligibility, cashless treatment, compliance with the Memorandum of Understanding (MoU), medical records, specialist availability, patient feedback, billing records, and infrastructure using a detailed inspection checklist covering patient care, clinical practices, ICU services, referral audits, billing, fraud indicators, and record maintenance. Following the inspection, reports shall be submitted to the Zonal Office, and hospitals with rectifiable deficiencies must submit a compliance report within 7–15 days.
[Notification no. - U-16012/268/2025-SST(E-1534916)]
