NEW DELHI: The National Health Authority, which implements the Centre’s Pradhan Mantri Jan Aarogya Yojana, turned down the proposal of specialist committees to increase package rates of nearly 15 “fraud-prone” treatments and procedures, this newspaper has learnt.
This includes hysterectomy, medical management of heavy menstrual bleeding and nephrolithotomy, among others.
The NHA had on Thursday announced a major and the first revision in the health package benefits offered under the scheme —dropping 554 packages out of a total of 1,393 and adding 237 new packages.
Sources said the specialist committees which consisted of heads of departments of AIIMS, Delhi and PGI, Chandigarh along with experts from Department of Health Research, Indian Council of Medical Research and Tata Memorial Hospital, carried out an extensive review of the existing packages and came up with a detailed list of suggestions.
“While 99% of its suggestions were adopted, the national anti-fraud unit flagged that if rates offered for hysterectomy and medical management of menstrual bleeding are raised, there will be more unnecessary admissions for these treatments,” said a source.
Hysterectomy has been one of the most abused surgeries under insurance plans.
“There had been a lot of deliberation to keep the price of abuse prone packages at the minimum level to minimize incentives for abuse,” an official said.