Wednesday, July 31, 2013

HC Judgement about cut-practice as business expense

THE COMMISSION PAID TO PRIVATE DOCTORS FOR REFERRING PATIENTS FOR DIAGNOSIS COULD NOT BE ALLOWED AS A BUSINESS EXPENDITURE.
                        Section 37 of the Income Tax Act, 1961 is a residuary provision.  In order to eligible for an allowance under this residuary provision the following conditions are required to be fulfilled:
·    The expenditure must not be governed by the provisions of Sections 30 to 36;
·    The expenditure must have been laid out wholly and exclusively for the purpose of the business of the assessee;
·    The expenditure must not be personal in nature;
·    The expenditure must not be capital in nature.
The explanation to Sec. 37(1) was inserted by Finance Act, 1998 with retrospective effect from 01.04.1962 which provides that it is declared that any expenditure incurred by an assessee for any purpose which is an offence or which is prohibited by law shall not be deemed to have been incurred for the purpose of business or profession and no deduction or allowance shall be made in respect of such expenditure.
                        The CBDT in Circular No. 772, dated 23.12.1998 explained the above explanation as Section 37 of the Income Tax Act is amended to provide that any expenditure incurred by an assessee for any purpose which is an offence or which is prohibited by law shall not be deemed to have been incurred for the purposes of business or profession and no deduction or allowance shall be made in respect of such expenditure.   This amendment will result in disallowance of the claims made by certain assessees in respect of payments on account of protection money, extortion, hafta, bribes etc., as business expenditure.   It is well decided that unlawful expenditure is not an allowable deduction in computation of income.  This amendment will take effect retrospectively from 01.04.1962 and will, accordingly, apply in relation to the assessment year 1962-63and subsequent years.
                        The issue to be discussed in this article is whether soliciting patients for diagnosis by paying commission to the private doctor is unethical, against public policy and forbidden by law with reference to decided case law..
                        In ‘Commissioner of Income Tax V. KAP Scan and Diagnostic Centre Private Limited’ – (2012) 344 ITR 476 (P&H) the assessee is a private limited company doing the business of CT scan, ultra sound and X-rays.  During the assessment proceedings for the assessment year 1997-98 in which the assessee filed its return declaring a loss of Rs. 24,40,650/-, it was found that the assesee had debited a sum of Rs. 3,68,400/- to the Profit and Loss Account as expenditure on account of commission paid to the practicing doctors who referred the patients to the assessee for various tests.   The Assessing Officer disallowed the said claim and considered it as deemed income under Section 115J of the Act.  On appeal by the assessee the Commissioner of Income Tax (Appeals) allowed the appeal and deleted the addition made on account of the commission.  The Revenue filed appeal before the Tribunal which dismissed the appeal holding that the commission paid to the doctors was an allowable expenditure being a trade practice and this gave rise to the Department to approach the High Court in the present appeal.
                        The assessee, before the High Court put forth the following arguments:
·    The question of admissibility regarding the deduction under Section 37(1) was never raised before the Tribunal and therefore the same cannot be raised before the High Court for the first time;
·    Giving of commission to the private doctors referring the patients for various medical tests was a trade practice which could not be termed to be illegal and, therefore, the same cannot be disallowed under Section 37(1) of the Act even after insertion of the Explanation to the said section by the Finance Act, 1998 with effect from 01.04.1962;
·    The Revenue had not shown, proved or argued that commission which was paid by the assessee was illegal practice and was not admissible as deduction.
The High Court considered the arguments of both sides.  To answer the first objection of the assessee the High Court held that the perusal of the orders passed by the Assessing Officer, the Commissioner of Income Tax (Appeals) and the Tribunal shows that the issue was with regard to admissibility of deduction of the commission paid by the assessee to the doctors for having referred the business to its diagnostic centre.  Once that is so, it cannot be said that the point with regard to Section 37(1) of the Act was never raised though it was only under the said provision.  Therefore the argument of the assessee does not carry weight.
                        The High Court further analyzed the provisions of Section 37, regulations of Medical Council of India in ‘The Indian Medical Council (Professional Conduct, Etiquette and Ethics), Regulations, 2002’ and Section 23 of the Contract Act.
                        The ‘The Medical Council (Professional Conduct, Etiquette and Ethics) Regulations 2002, describes some of the unethical acts under Chapter 6 as follows:
·    Regulation 6.4 provides that no physician shall give, solicit, receive, or offer to five, solicit or receive, any gift gratuity, commission or bonus in consideration of a return for referring any patient for medical treatment;
·    Regulation 6.4.1 provides that a physician shall not give, solicit or receive nor shall he offer to give solicit or receive, any gift, gratuity, commission or bonus in consideration of or return for the referring, recommending or procuring of any patient for medical, surgical or other treatment.   A physician shall not directly or indirectly, participate in or be a part to act of division, transference, assignment, subordination, rebating, splitting or refunding of any fee for medical, surgical or other treatment;
·    Regulation 6.4.2 provides that the provisions of para 6.4.1 shall apply with equal force to the referring, recommending or procuring by a physician or any person, specimen or material for diagnostic purposes or other study/work.   Nothing in this section, however, shall prohibit payment of salaries by a qualified physician to other duly qualified person rendering medical care under his supervision.
On analysis the High Court held that if demanding of such commission was bad, paying it was equally bad.   Both were privies to a wrong.   Therefore, such commission paid to private doctors was opposed to public policy and should be discouraged.  The payment of commission by the assessee for referring patients to it cannot be any stretch of imagination be accepted to be legal or as per public policy.   Undoubtedly the High Court held that it is not a fair practice and has to be termed as against the public policy.
                        The High Court analyzed Section 23 of Contract Act which provides that the consideration or object of an agreement is lawful, unless-
·    it is forbidden by law; or
·    is of such a nature that, if permitted, it would defeat the provisions of any law; or
·    is fraudulent; or
·    involves or implies, injury to the person or property of another; or the court regards it as immoral, or opposed to public policy.
In each of these cases, the consideration or object of an agreement is said to be unlawful.   Every agreement of which the object or consideration is unlawful is void.
The High Court held that Section 23 of the Contract Act equates an agreement or contract opposed to public policy, with an agreement or contract by law.  Thus the commission paid to private doctors for referring patients for diagnosis could not be allowed as business expenditure.  The amount which can be allowed as business expenditure has to be legitimate and not unlawful and against public policy.    The High Court allowed the appeal of the Revenue.                     
Downloaded from internet


Tuesday, July 30, 2013

CUT-PRACTICE- Letter to Health Minister

From,
Dr Vani Kulhalli,
Vile Parle East,
Mumbai-57
To,
Minister for Medical Education,
Government of Maharashtra,
Mumbai.
Date 22-7-2013
Subject-  Regarding complaint by Dr Himmatrao Bawaskar against P M Medical Centre, Pune
Respected Sir,
You may be aware that Dr Himmatrao Bawaskar has complained to the Maharashtra Medical Council  that P M Medical Centre, Pune attempted to pay him commission for the ‘service’ of referring a patient to them for investigation.  In other word, he has complained against ‘cut-practice’.
You have been a Minister for a long time now. I am sure you may be aware of the horrible financial, emotional and medical consequences of this practice. Yet nobody is able to protect patients from its vile grip. This is because it is a well-organised practice. Furthermore, the existing laws are insufficient to provide for investigation and prosecution. Firstly the law states it merely ‘unethical’ whereas it is actually an organized financial crime. Secondly the current law is applicable only to individual doctors, whereas doctors give and take cuts in the names of hospitals, diagnostic centres etc.
 While you have taken several initiatives to improve healthcare in Maharashtra, I feel you must also take some more measures to curb malpractices.  I call upon you, a law-maker,  to deliberate on this at the highest levels and bring in a law to make cut-practice illegal and punishable. Please extend the law to any organization or individual providing healthcare, so that everyone is covered by it.
As a practicing doctor and a potential patient, I observe with pain and grief, the extent of cut-practice and wish strongly that some legal measures should be available to remedy the situation.
Copy to
1.      Chief Minister, Maharashtra
2.      Minister of Health and Family Welfare
Sincerely,

Dr Vani Kulhalli

Sunday, July 21, 2013

Cut-practice- Letter to MMC President and members



From,


Dr Vani Kulhalli
Vile Parle East,

Mumbai-57


To,

President and other Esteemed Members

Maharashtra Medical Council,

Mumbai.

Date 16-7-2013

Subject- Referral to higher authority of complaint by Dr Himmatrao Bawaskar against P M Medical Centre, Pune

Respected Sirs and Madam,

I am writing with the hope that Dr Bawaskar’s case will reach its logical conclusion in your able hands.

In addition to sorting out the present complaint, I think that the Council should refer the matter to appropriate investigative agency to establish facts. I also feel that the Council should carry out appropriate study and avail of Legal expertise to discuss the problem of ‘cut-practice’ and its remedies. Such initiative has not been earlier taken. (Ref Enclosure).

Maharashtra Medical Council is severely handicapped by lack of jurisdiction and competence in taking adequate action against cut-practice, as a whole. A beginning can be made now by extending the scope of your work to establish the nature and extent of cut-practice and establishing deterrents. I request you to lodge a proper Police Complaint and refer matter to High Court/ Legal Cell of Government of Maharashtra to achieve the above stated aims.

Dr Bawaskar’s complaint should be treated as an opportunity for the Council to deliberate on corruption in private medical practice. I exhort you to take it upon yourself as a sacred duty; you may be able to redeem the lost prestige of our profession to some extent. Please do not let go of this chance to make history and change medical practice for the better.

Enclosure

Transcript of RTI application and reply made by me in February 2012

With lots of Hopes from You

Sincerely,



Dr Vani Kulhalli



cut-practice-Letter to CJ, HC mumbai



From,


Dr Vani Kulhalli

Vile Parle East

Mumbai-57



To,

Honorable Chief Justice

High Court of Mumbai

Mumbai.



Date- 9-7-2013



Subject- Petition to intervene in the matter of Dr Bawaskar vs P M Medical Centre, Pune currently being handled by the Maharashtra Medical Council (MMC)



Respected Sir,



I am a Psychiatrist practicing in Mumbai for the last 10 years. I have seen the harm done to the community by ‘cut-practice’ and believe that it is a horrible form of corruption that should be immediately stopped. In this regard, I had filed RTI applications to the Medical Council of India and Maharashtra Medical Council in 2012 (enclosure). Although the Indian Medical Council Regulations of 2002 mentions cut-practice as illegal, there is no mention of the procedures to establish the misconduct or the quantum and nature of punishment. I was also surprised that the Councils had not even thought of setting up a group/ committee to deliberate in this matter in the several decades of their existence!



All members of the current MMC are doctors or beaurocrats. They are not well versed in judging misdemeanors of this (financial and ethical) nature. Their role in this case will be limited to merely hear the case and settle it. Secondly, they are mostly busy doctors doing the council work in honorary capacity and cannot spare the time or energy required. Thirdly, being doctors it will not be easy for them to be objective in the respect of a practice that has spread its tentacles over most of the medical community. Sometimes fraternal ties make it difficult to give out proper decisions. Therefore, I have serious doubts about the competence and credibility of MMC to handle this case.



The procedure used for settling this case will only involve hearing both parties. No investigation will be done to establish the facts of the case. For example, simply checking other cases handled by the diagnostic centre will be able to tell us whether it routinely reimbursed ‘professional charges’ to doctors for the favour of referring patients (in other words, did cut practice). So the question of a misunderstanding arising in this particular case only, will not arise. I fear that this type of investigative approach will not be taken for the reasons stated above. The whole purpose of the complaint and the intention of the complainant to cleanse medical practice will be lost.



A patient goes to his doctor in pain and desperation, with a hope not only of treatment but also of empathic guidance and support. If the doctor is motivated by empathy and informed by scientific facts, this patient can get what he needs. This is a basic human right. There is no law that forbids the doctor from framing and then claiming his/ her fees for this service. That amount may be high or low, as per the doctor’s judgement. Inspite of this, it is my personal experience that all patients pay the fees asked of them. Then what is the need to fool the patient into paying through cut-practice network?



Thus cut-practice is not motivated by lack of income alone. It is the work of a perverse mind motivated by a criminal intent. This is perpetrated by group of individuals who seek to defraud the patient and are unconcerned with the risk that the patient is exposed to, in undergoing unnecessary tests and surgeries. Therefore, it should be classified as a premeditated criminal activity done with the astute planning of an intelligent but sick mind. All sections of society and every profession have such members. In the medical community, they are represented by professionals who believe cut-practice is their entitlement. This makes it necessary to punish the holders of such malafide intent to protect humanity.



Further, it gives unfair advantage those doctors who are corrupt and can be justly termed as an ‘illegal trade practice’. A group of such doctors form a cartel and edge out other doctors. The doctor or hospital who bribes corners a large clientele and this affects the morale of non- corrupt doctors. It is now known that such persons are able to get income tax benefits as paying ‘referral charges’ has been ruled as a legitimate business expense. The doctor who refers the patients need not use his/ her skills as a doctor as the income from kickbacks frequently exceeds income from hard work and is home-delivered by a ‘P R O’. (Public Relations Officer)



A person who pays a bribe to get some work done does it for himself, is aware that he is paying, is aware why he paying it, is aware to whom he is paying and at least some of the times, has the choice not to pay. The hapless patient has no idea that he/ she has been taken for a ride by the doctors with whom he/ she trusted his life. The very nature of cut-practice makes it impossible for the victim to take precautions. The victim will never be able to get redress even if he becomes aware; a strong sense of fraternity will prevent any doctor from being a witness and there are no other witnesses in this crime. Therefore cut practice is the worst form of corruption and it denies the patient his basic human rights. And that is why Dr Bawaskar’s case is of extreme importance. For the first time, we have a doctor willing to go on record and remedy the practice and he has followed the proper procedure.



According to me cut-practice is a crime against humanity. It is so well organized; I wish the doctors should be booked under MCOCA or some such similar law. I feel it is an economic offence against the state, where the recipients of kickbacks are not paying the proper taxes due to invisible transactions whereas the kickback generators are evading tax in the name of business expense. There is artificial inflation of medical costs as the kickbacks amount to anything between 40-60% of medical expenses. It is destroying the moral fabric of medical community by making the wrong people rich and successful. Cut practice is an insidious and horrible practice that hits out at the very base of humanity. I have now seen the worrying trend of specialist doctors doing general practice only for the sake of cashing in on this cut-practice trend.



I plead to your Kind Lordship to take cognizance of the extreme importance of this case. A rare case such as Dr Bawaskar’s, is a once in the life time opportunity to give out a strong message of zero tolerance to cut-practice. Cut- practice is a serious crime. I and others like me, think that it is a matter in the public interest and Maharashtra Medical Council does not have sufficient stature or competence to deliberate on a matter of such national and human importance. It is our humble plea that the case should be handled by an August and eminently competent body such as the Honorable High Court itself. The case should be investigated by a proper agency such as Police or Economic Offences Wing and case pleaded by proper lawyers. The Honorable Court may deem fit to suo moto issue relevant guidelines or at least appoint a observer of proven integrity to monitor and report to the Honorable High Court and His Kind Lordship about the proceedings in this case.



Enclosures

Contents of application to Medical Council

of India and Maharashtra Medical Council

under RTI Act 2005

With Highest Hope from You, Sir

Sincerely,

Dr Vani B Kulhalli



_______________________________________________________________________________

RTI Apploication to MCI in Feb 2012

In the last ten years, that is during the period from January 2002 to December 2011, regarding ‘cut-practice’ by which I mean the system of a doctor giving commission to another doctor for the ‘service’ of referring patients:



1. Against how many doctors has the Medical Council of India (MCI) received complaints for doing cut-practice? I want to know the total numbers including those giving as well as those receiving cuts.



2. How many doctors suspected of doing cut-practice were investigated by MCI?



3. In case the allegation of cut-practice against any doctor was proved to be true, what was the punishment/ penalty imposed on such a doctor?



4. Did the MCI receive any complaints that a hospital/ nursing home/ diagnostic centre or such other commercial establishment rendering medical services, was involved in cut-practice? If yes, how many complaints were received?



5. How many complaints of cut-practice against commercial medical establishments were investigated by the MCI?



6. In case any commercial medical establishment was found to be engaging in cut-practice, what was the punishment/ penalty imposed?



7. Has there been any request to Medical council of India to designate cut-practice as an illegal activity tantamount to corruption?



8. Has there been any plan/ proposal of the MCI to declare cut-practice as a form of corruption?



REPLY Dated-28-3-2012

Total number of complaints, that is, 588 against doctors working in private practice/ nursing homes/ private hospital/ Govt. hospital during January 2011 to March 2012 has been received by council. It is further to state that no complaint has been received for doing cut-practice.

MCI has prescribed the Indian Medical Council (Professional Conduct, etiquette and Ethics ) Regulations, 2002 which is available on website www.mciindia.org. The Council does not maintain the data in the manner in which it is sought for.

It is further stated that the queries are in the nature of eliciting opinion and therefore, it does not constitute information as defined under u/s(f) of the RTI Act 2005.

Signed

Dr Davinder Kumar

Joint Secretary and PIO




--------------------------------------------------------------------------------------------------------

rti application to MMC


Nature of Information required



In the last ten years, that is during the period from January 2002 to December 2011, regarding ‘cut-practice’ by which I mean the system of a doctor giving commission to another doctor for the ‘service’ of referring patients:



1. Against how many doctors has the MMC received complaints for doing cut-practice? I want to know the total numbers including those giving as well as those receiving cuts.



2. How many doctors suspected of doing cut-practice were investigated by MMC?



3. In case the allegation of cut-practice against any doctor was proved to be true, what was the punishment/ penalty imposed on such a doctor?



4. Did the MMC receive any complaints that a hospital/ nursing home/ diagnostic centre or such other commercial establishment rendering medical services, was involved in cut-practice? If yes, how many complaints were received?



5. How many complaints of cut-practice against commercial medical establishments were investigated by the MMC?



6. In case any commercial medical establishment was found to be engaging in cut-practice, what was the punishment/ penalty imposed?



7. Has there been any request to MMC to designate cut-practice as an illegal activity tantamount to corruption?



8. Has there been any plan/ proposal of the MMC to declare cut-practice as a form of corruption?



RTI Query filed in February 2012, answer received in same month

Ref no-MMC/ RTI/ 04450/ 2012/ 2543

Answers received were

1. As of date MMC has not received any complaint for doing cut-practice, against any individual doctors

2. & 3. Not applicable

4. As of date MMC has not received any complaint against any hospital/ nursing home/ diagnostic centre

5,6,7. Not applicable

8. No proposal pertaining to cut-practice is tabled in MMC.



Signed-Dr Ramesh Dahigaonkar, Information Officer/ Registrar, MMC




Tuesday, July 16, 2013

cut-practice letter. what happened?

A few days ago, I had uploaded a letter on this blog. Well, the letter needed to be removed for the time-being as it is to be considered as 'privileged' communication till such a time as a response is received.

I want my efforts to succeed and am keen that nothing goes wrong. So presently I am keeping my fingers crossed and my efforts low- profile. I definitely am not doing it for the publicity; so there is really no need to talk much now. We will talk about it VERY LOUDLY when the time comes.