Commission for quacks: How private hospitals in Telangana profit from unqualified practitioners

Private hospitals and diagnostic centres in Telangana are allegedly encouraging Rural Medical Practitioners (RMPs) and Paramedical Practitioners (PMPs), commonly labelled as quacks, to refer patients to their facilities, offering them up to 40% of the total bill as commission.

The practice of unqualified medical practitioners operating so-called ‘first aid centres’ has been rampant in Telangana for decades. To curb the menace, the District Medical and Health Officer (DMHO) of Nizamabad, Rajasree issued a circular on September 17 cautioning private hospitals against indulging in such practices. The circular warned of stringent action under the Clinical Establishment Act, 2010, along with disciplinary measures against managements found guilty.

A senior government doctor said the problem extends far beyond Nizamabad. “In Karimnagar, Nizamabad and parts of Nirmal, commissions go up to 50 to 60%. Ten years ago in Karimnagar, it was already at 30 to 40%. Nirmal joined later, but now it is the same everywhere. For instance, if a hospital offers a package costing ₹5 lakh for a treatment, RMPs get paid ₹1.5 lakh from it. In corporate hospitals, the cut is about 10%, while in nursing homes, it ranges from 30% to 60% depending on the place,” the doctor said.

The doctor further noted that such incentives have extended even to outpatient referrals and diagnostic laboratories: “It is illegal and dangerous, but the system has sustained because doctors themselves are encouraging RMPs and PMPs. It has become a matter of competition and survival.”

Meanwhile, the Telangana Medical Council (TGMC) has been conducting raids and inspections at clinics and centres run by unqualified medical practitioners. Recently, TGMC suspended five doctors for professional misconduct and ethical violations under the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002, and the Telangana Medical Practitioners Registration Act, 1968.

The suspended doctors were found to be involved in sponsoring events for quacks, misrepresenting themselves as cosmetologists and hair transplant surgeons, and displaying unrecognised qualifications not recognised by the National Medical Commission (NMC).

TGMC vice-chairman Srinivas said the problem is not limited to rural areas. “The issue is prevalent even in cities like Hyderabad. Some multi-speciality and super-speciality hospitals are giving rebates and commissions because patients are being referred by RMPs for investigative tests. Patients from rural areas and towns are being directly referred for CT scans, MRIs, anaesthesia and other tests. On the total bill, doctors are getting 30-40% commission,” he explained.

Calling for structural reforms, Kiran Madala, professor at Gandhi Medical College, Secunderabad, said, “The government must provide infrastructure in rural areas to encourage young doctors to set up nursing homes and hospitals there. Only then can this system be removed. Unless the root cause is addressed, piecemeal action will not work. The government must be strict enough to curb RMPs.”