Introduction
It is common knowledge that patients visit hospitals, doctors’ clinics, or nursing homes for consultation, diagnosis, procedures, emergency treatment, or surgery without being fully aware of the charges involved. When the bill for such services is presented, patients or their families, unaware of the costs, are often taken aback and find themselves in a helpless situation.
There is, therefore, a need for a uniform law to be legislated across all States and Union Territories of our country. Such legislation should ensure that patients are provided with full details in advance by displaying tariffs at various locations within the healthcare establishment for all services offered.
Fee transparency is a crucial component of the broader right to health guaranteed under Article 21 of the Constitution of India. It also aligns with the consumer’s right to be informed, as enshrined in the Consumer Protection Act, 2019.
Patients cannot give truly informed consent or protect themselves from overcharging unless they are aware, in advance, of the costs of each consultation, diagnostic test, procedure, or bed category.
Health is a human right and a prerequisite for the overall development of a nation. It is described as a state of complete physical, mental, and social well-being. Article 21 of the Constitution mandates the protection of “life” and personal liberty. Moreover, the Directive Principles of State Policy, under Article 47, emphasize that it is the duty of the State to improve public health.
The Apex Court has consistently held that under Article 47, the State is obligated to raise the standard of living and improve public health. In the landmark case of State of Punjab and Others v. Mohinder Singh Chawla [(1997) 2 SCC 83], it was categorically held that the “Right to health is integral to the right to life” and that the “Government has a constitutional obligation to provide health facilities”.
The Apex Court further observed in State of Punjab v. Shiv Ram and Others [(2005) 7 SCC 1] the growing commercialization of the once noble medical profession:
“In recent times the self-regulatory standards in the profession have shown a decline and this can be attributed to the overwhelming impact of commercialisation of the sector. There are reports against doctors of exploitative medical practices, misuse of diagnostic procedures, brokering deals for sale of human organs, etc. It cannot be denied that black sheep have entered the profession and that the profession has been unable to isolate them effectively.
The need for external regulation to supplement professional self-regulation is constantly growing. The high costs and investments involved in the delivery of medical care have made it an entrepreneurial activity wherein the professionals look to reaping maximum returns on such investment. Medical practice has always had a place of honour in society; currently, the balance between service and business is shifting disturbingly towards business and this calls for improved and effective regulation, whether internal or external.
There is need for introspection by doctors – individually and collectively. They must rise to the occasion and enforce discipline and high standards in the profession by assuming an active role.”
The Statutory Backbone
The Clinical Establishments (Registration and Regulation) Act, 2010 was legislated by the Parliament and came into force in 2012. The said Act mandates, inter-alia, to register and regulate clinical establishments across India, ensuring minimum standards of facilities and services.
The Central Rules, 2012, framed by the Union Ministry of Health & Family Welfare, provide the framework for implementing the Act. These rules mandate registration for all clinical establishments, including diagnostic centers and single-doctor clinics, in both public and private sectors.
The Clinical Establishments (Registration and Regulation) Act, 2010, aims to standardise and regulate clinical establishments in India. The Central Government Rules, 2012, further elaborate on these standards, including specific requirements for registration and operation. Rule 9 addresses conditions for registration and continuation of clinical establishments.
Prominent Rules
The prominent rules are Rule 9(i) & Rule 9(ii) of the Central Rules, 2012, which read as under:
- Rule 9(i): “Every clinical establishment shall display the rates charged for each type of service provided and facilities available, at a conspicuous place, in the local language and English.”
- Rule 9(ii): “The clinical establishments shall charge the rates for each type of procedures and services within the range of rates determined and issued by the Central Government or the State Government as the case may be, from time to time.”
The Clinical Establishments (Registration and Regulation) Act, 2010, has been adopted by twelve states and all Union Territories (except Delhi). These states include: Sikkim, Mizoram, Arunachal Pradesh, Himachal Pradesh, Uttar Pradesh, Bihar, Jharkhand, Rajasthan, Uttarakhand, Kerala, Karnataka, and Assam.
Core Provision on Price Display & Penal/Remedial Clause
The said Act provides for penalties and also cancellation/suspension of registration for offending the requirements of the various provisions of the Act. The penalties provided under the Central Act are reproduced thus:
Chapter VI — Penalties
Section 40. Penalty.
Whoever contravenes any provision of this Act shall, if no penalty is provided elsewhere, be punishable:
- For the first offence: with fine which may extend to ten thousand rupees.
- For any second offence: with fine which may extend to fifty thousand rupees.
- For any subsequent offence: with fine which may extend to five lakh rupees.
Section 43. Penalty for Minor Deficiencies.
Whoever contravenes any provision of this Act or any rule made thereunder resulting in deficiencies that do not pose any imminent danger to the health and safety of any patient and can be rectified within a reasonable time, shall be punishable with fine which may extend to ten thousand rupees.
Non-compliance with Rule 9(i) and 9(ii) of the Clinical Establishments (Central Government) Rules, 2012, can lead to penalties under the Clinical Establishments (Registration and Regulation) Act, 2010. Penalties for non-compliance can include fines and other actions, as outlined in the Act.
For violating the Act’s provisions, penalties can range from ₹10,000 for the first offense to ₹5,00,000 for subsequent offenses. However, State Acts may have different penalties. For instance, the Karnataka Private Medical Establishments Act, 2017 mandates a penalty up to 3 times the over-charged amount or ₹1 lakh.
Interplay with Consumer-Law Doctrine
Failure to exhibit a tariff constitutes an unfair trade practice (s. 2(47), CPA 2019) for concealing material information about price. It also implies deficiency in service that attracts compensation, restitution of over-charged sums, and even punitive damages in egregious cases. Additionally, it amounts to professional misconduct under the National Medical Commission (Professional Conduct) Regulations, 2023, which require “honest billing.”
It is pertinent that Consumer Commissions have consistently fined hospitals and compensated patients for overcharging and not displaying tariffs/fees:
- BMS Hospital, Bengaluru was fined for charging a hidden ₹150 registration fee and for not displaying the policy.
- Durg District Forum (Chhattisgarh) ordered refund and awarded damages where a package brochure was absent and the patient was over-billed by ₹1.85 lakh.
- NCDRC (2018) awarded ₹1 lakh cost for misleading advertised rates for angioplasty.
Compliance Checklist for Hospitals
- Dual-language tariff board at the main entrance & reception
- Website & digital kiosk (Kerala 2024 Amendment encourages touch-screen kiosks)
- Granularity: break-down of OPD, bed charges, procedure packages, diagnostics, implants/consumables
- Update protocol: whenever prices are revised, display must be updated before the new rates take effect
- Package brochure / QR code for procedures
- Itemised bill that tallies exactly with displayed rates; any discount or exception must be foot-noted
- Audit trail: preserve screenshots or photographs of the board whenever prices are changed to rebut future allegations
Judicial Reinforcement
The Kerala High Court (Kerala Private Hospital Assn. v. State of Kerala, 2025) dismissed a constitutional attack on the fee-display mandate, holding that:
“Transparency in billing is integral to patient safety and ethical standards.”
The Court, in WP(C) 1365 of 2019 & Connected Cases titled Kerala Private Hospital Association and Another v. State of Kerala and Others, decided on June 23, 2025, upheld provisions of the Kerala Clinical Establishments (Registration and Regulation) Act, 2018 and Rules, including the requirement for fee display.
“Every clinical establishment shall display, in a conspicuous place in the clinical establishment in Malayalam as well as in English, the fee rate and package rate charged for each type of service provided and facilities available, for the information of the patients.”
The Court further ruled that clinical establishments shall not charge more than what is displayed.
Earlier, in Sabu P. Joseph (Adv.) v. State of Kerala and Others [2021 (4) KHC 225], the High Court directed private hospitals in the State to display service rates as per Section 39 of the Act.
“In the light of the afore, the petitioners are not entitled to raise any challenge with reference to Section 39, as noticed above. This is all the more so, since the petitioner in W.P(C)No.1365 of 2019 (Kerala Private Hospitals Association) and the petitioner in W.P(C) No.29353 of 2019 (Indian Medical Association) were the additional 5th and the 9th respondents respectively before the Division Bench of this Court and it is after hearing them also, that the Division Bench issued the directions as above.”
Supreme Court – Matter Sub-Judice
The Supreme Court in May 2025 issued notice on a PIL demanding enforcement of Rules 9(i) & (ii) and warned the Centre that it may “freeze CGHS rates” if uniform limits are not framed.
Earlier, on 28 Feb 2024, the Court orally remarked that the State “cannot shirk its responsibility” to standardise charges, noting cataract prices of ₹10,000 vs ₹1.4 lakh.
The PIL filed by Voice Society seeks enforcement of these rules across all applicable States and Union Territories, including mandatory display of service rates and adherence to price ranges set by the Central Government in consultation with State Governments.
The case has been listed alongside a similar pending matter, signaling a potential judicial move toward price regulation and implementation in the healthcare sector.
It is indeed a matter of grave concern that all the State Governments have not yet enacted State Laws. It is all the more distressing that wherever this model act has been enacted in all the States & Union the Supreme Court, the implementation is a big zero. The Government’s apathy to the Consumer Rights is indeed deplorable. It is indeed a Mockery of Law that in spite of State legislation, the clinics/ medical establishments do not display fee/tariff. It is high time Laws should be made stringent and strict compliance agencies be deployed, penalties enhanced and prosecution introduced for non compliance.
Laws should be for implementation not just Ornamentation. It is earnestly hoped that the Apex Court would issue binding directions to the erring states to adopt the Central Act and to direct the State Authorities to implement the said Act & Rules in true spirit so that the common man is made aware and also stand benefitted. The Apex Court’s stance on standard-rate caps would in all certainly reshape the sector’s pricing freedom & create awareness towards prevailing tariffs & fees & benefit the common man.
Written By: Inder Chand Jain
Ph no: 8279945021, Email: [email protected]
