RAIPUR: Chhattisgarh was bestowed with an award as “best performing state” for its effective execution, transparency and almost zero pendency on health care insurance claims and related issues under the Pradhan Mantri Jan Arogya Yojana (PM-JAY).
The award was received by Dr Priyanka Shukla, chief executive officer (CEO) of the state nodal agency at the National Health Authority (NHA) Conclave held in Bhopal on Wednesday.
At the NHA review meeting in January 2025, Chhattisgarh was found to have a relatively high number of suspicious claims. To improve this situation, the state nodal agency developed and implemented a swift action plan to strengthen accountability and transparency in health services.
The nodal agency has taken steady, resolute steps in recent months, including conducting extensive field audits to identify suspicious claims, significantly reducing the turnaround time (TAT) for claims processing, orientation and sensitivity training for all stakeholders, strengthening the State Anti-Fraud Unit (SAFU) team, and establishing regular communication and coordination mechanisms with empanelled healthcare providers (EHCPs).
Besides intensive reviews at district and state level by the health secretary and CEO (state nodal officer), the health department team conducted surprise inspections of many hospitals across the state. Penalty action was taken against 45 hospitals (the highest ever) for non-compliance with the scheme's standards. Additionally, field audits were conducted in over 32,000 cases, preventing fraudulent claims and making the claim settlement process more transparent.
Regular meetings are being held with representatives of the Indian Medical Association and private hospitals to address issues faced by empanelled hospitals.
According to data from the National Health Authority, 97 percent of hospitals (the highest) registered under PM-JAY in Chhattisgarh are active, a testament to hospitals' confidence in the scheme. In contrast, this rate in neighbouring Madhya Pradesh is 62 %, and the national average is only 52 percent.
Chhattisgarh Health Minister Shyam Bihari Jaiswal congratulating the department officials, said, “The state government's goal remains to provide quality and respectable healthcare to all eligible families”.
The Ayushman Bharat Scheme was included as an agenda for the first time in the recently held Collectors' Conference, chaired by CM Vishnu Deo Sai in Raipur. CM Sai has directed all collectors to conduct regular reviews of the scheme in their respective districts.