NEW DELHI: Five months after the launch of the Union government’s big-ticket national health insurance scheme Pradhan Mantri Jan Aarogya Yojana, cases of fraud are already cropping up.
Two hospitals in Jharkhand, caught admitting more patients than the number of beds present and charging money for diagnostics from beneficiaries, have been apprehended for “fraud” and are being barred from offering the scheme.
Officials at the National Health Authority, the agency which was constituted to implement the scheme, said that a possible fraud was alerted from two hospitals, first during daily auditing and then verified by state health authorities.
The two hospitals are Nagarmal Modi Seva Sadan in Ranchi and PVTG hospital in Ramgarh. “We have asked states to suspend the empanelment of hospitals and issue a show-cause notice,” Indu Bhushan, CEO of the NHA, said. “There is a 6-8 per cent chance of fraud anywhere in the world through health insurance schemes but whenever we catch a hospital doing it, we will give exemplary punishment.”
So far 15,000 hospitals have been empanelled for the scheme —nearly half of them are private hospitals — and over 13.2 lakh patients have been hospitalized. Deepa V of Jan Swastha Abhiyan, a group that called for the abandonment of the PMJAY on Monday while releasing people’s health manifesto ahead of 2019 general elections, said it follows “discredited” insurance model, stressed that the programme is open to malpractices by private hospitals.
“Rashtriya Swastha Bima Yojana, which was run by the Centre for nearly 10 years and several other state government health insurance schemes, have been marred with moral hazards. It would be foolish to expect honesty from private hospitals when so much money is involved,” she said.
The health scheme
Pradhan Mantri Jan Aarogya Yojana promises hospitalization benefit to 50 crore Indians for nearly 1,400 procedures and surgeries with a coverage limit of up to D5 lakh. It was rolled out officially on September 23 last year