In a significant verdict delivered on June 3, 2025, the Kerala High Court quashed the State Government’s Order imposing an internship fee on Foreign Medical Graduates (FMGs) undergoing their Compulsory Rotating Medical Internship (CRMI) in the State. They held the order contrary to the policy of the National Medical Commission (NMC) and without statutory backing. The judgment, delivered by Justice N. Nagaresh, declared the fee illegal, emphasising that the State had no legislative or regulatory authority to levy it.
The case arose from a series of writ petitions, including, Sharooq Mohammed & Ors. v. State of Kerala & Ors., filed by FMGs who challenged the Kerala Government’s order (GO(Rt) No.987/2025/H&FWD dated April 3, 2025., which mandated them to pay ₹5,000 per month, totalling ₹60,000, over the course of a one-year internship as a fee for their Compulsory Rotating Medical Internship (CRMI) in government hospitals.
The petitioners, who completed their medical education abroad and were undergoing CRMI in Kerala to qualify for registration in India, argued that the State’s levy was illegal, arbitrary, and violated the National Medical Commission (NMC) guidelines. The NMC, through its 2022 circular, had categorically stated that no fee should be charged from FMGs for internships, although it left the question of stipends to the discretion of the institution or state. N. Nagaresh, J. concurred with the petitioners and held that:
“There is no statutory provision enabling the respondents to collect any amount from the Foreign Medical Graduates for undergoing internship.”…“It is the National Medical Commission, alone, which is empowered under the law to prescribe the standards and requirements for internship to be undergone by the Foreign Medical Graduates.”
The Court noted that there exists no Central or State legislation authorising such a fee for internships, which are akin to apprenticeships. Importantly, the Court emphasised that while apprenticeships are regulated under the Apprentices Act, 1961, internships in medical education are governed solely by the NMC Regulations of 2021, which are silent on fees but affirm the NMC’s exclusive domain over such policies.
The Court also addressed the State’s argument that the fee covered administrative and infrastructure costs:
“The mere fact that the Government is incurring expenditure for training of the petitioners, cannot be a reason to impose a fee in violation of the law laid down by the Apex authority, namely the National Medical Commission.”
Apart from the legal grounds, the Court also reasoned that the non-levy of internship fees was justified by the principle of mutual benefit. It observed that hospitals receive valuable services from Foreign Medical Graduates (FMGs), as they are involved in examining patients, prescribing medications, and, in some cases, even performing minor surgical procedures under supervision. In return, FMGs gain practical experience and clinical exposure. This reciprocal arrangement, the Court held, adequately compensates both parties and negates the need for an additional financial burden in the form of internship fees.
Court placed reliance on a previous Division Bench judgment in The Association of MD Physicians v. State of Kerala, and reiterated that internship fees contradict both NMC guidelines and judicial precedent. The Bench had earlier instructed the State to align its fee policy with the NMC’s stance. Instead, the State’s subsequent order to levy the fee was found to be in violation of that direction.
The Court concluded that the Government Order dated April 3, 2025, was ultra vires the NMC Act and struck it down. FMGs undergoing CRMI in Kerala are now entitled to complete their internships without paying any internship fee to the State or institutions.
This ruling comes as a major relief to hundreds of FMGs who were facing financial and administrative hurdles due to the disputed fee. It also reaffirms the centrality of the NMC in regulating medical internships and ensures uniformity in policy implementation across states.
Case Name– Sharooq Mohammed & Ors. v. State of Kerala & Ors. and Connected Cases
Case Number– W.P.(C) Nos.. 19369, 19383, 19776, 19908, 20000, 20045, 20172, 20195 and 20259 of 2025
Bench– Justice N. Nagaresh
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