Government may ask TPAs to get audited by external auditors to check delay in settlement of claims

The government may ask third party administrators (TPA) that provide cashless medical insurance service to undergo external audit following complaints of delays in settling claims.  “We have received number of complaints over delayed settlement of claims. There is also an issue of one TPA working for more than one insurance firm, leading to delay in processing,” said an official who did not wish to be named.

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Applicability of TDS in case of Third Party Administrator (TPA) providing health insurance claim services.

SUMMARY OF CASE LAW

Having regard to the agreement entered into inter se between the hospital and the TPA for payment of money to the hospital, it cannot be said that the TPA, who is the authority or the person to pay the amount to the hospital, is not required to deduct the tax at source and section 194J is not attracted.

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