KATHMANDU: The Health Insurance Board has issued a strict directive to all affiliated hospitals to cease unnecessary patient referrals.

A circular sent to service providers mandates that institutions must provide treatments available within their own facilities instead of referring patients elsewhere without justification.

The Board noted that many hospitals are referring patients even when local services are available, violating the Health Insurance Act 2017, the Health Insurance Regulations 2018, and the Referral Procedures 2023.

If a facility cannot provide a specific service, it must issue a formal referral form to the nearest guaranteed provider.

To ensure compliance, the Board warned it will refuse reimbursement for claims involving unjustified referrals.

Repeated violations may result in the suspension or immediate cancellation of the hospital’s service agreement.