india

Updated: Mar 31, 2019 03:24 IST

Hospitals found to be charging beneficiaries of Ayushman Bharat money for treatment and other kinds of wrongdoing will risk having their accreditation to the government-sponsored health insurance programme suspended and having their payments withheld, a senior official said.

If the charges are established after an inquiry, a first information report may be lodged with the police, and the hospitals will risk losing their licences to offer health services .Until now, hospitals were issued a show-cause notice if irregularities were found and action taken after an investigation.

The Ayushman Bharat-Pradhan Mantri Jan Arogya Yojna (AB-PMJAY) , launched in September last year, provides an annual hospitalisation cover of Rs 5 lakh to around 100 million families in at least 16,000 empanelled hospitals. It is billed as the world’s largest public health insurance programme.

“We have decided to take stricter action against any kind of fraud, and the states have been directed to suspend the PMJAY licence immediately if there’s prima facie evidence against a hospital. After detailed inquiry, depending on the nature of fraud, we may recommend to the state licensing authorities to suspend the hospital’s licence to operate. We will also file an FIR for fraud,” said Dr Dinesh Arora, deputy CEO, National Health Authority (NHA), the central implementing agency of AB-PMJAY.

Licences of two hospitals— Nagarmal Seva Sadan and PVTG Hospital— in Jharkhand were suspended earlier this month after the NHA’s medical audit team found serious irregularities during on-site investigations of hospitals in the state.

“…the medical audit team identified that money for diagnostics was being collected from beneficiaries, e-cards were being retained by the hospital, there was a mismatch between empanelment details and onsite facilities etc,” NHA wrote to the state principal secretary in a letter seen by HT.

“We recommend temporary suspension… from implementation of PMJAY and withhold their payments till a detailed inquiry is complete,” the NHA letter added.

Two hospitals in Chhattisgarh and one in Uttar Pradesh are also under the scanner.

“We want to make this scheme not only the largest but most well implemented scheme in the world. We have created enough mechanisms to prevent and mitigate frauds and abuse. Still, if any such incident of illegally taking government money comes to our knowledge it will be dealt with in the harshest manner,” said Indu Bhushan, CEO of NHA.

The hospitals say committing irregularities is not common.

“Most empanelled hospitals are sincerely offering services under the scheme. There may be some defaulters but their number would be few and far between. It’s a new scheme, so there will be challenges in the beginning but over time people will come up with proper solutions to deal with them,” said Dr DS Rana, chairman, board of governors, Sir Ganga Ram Hospital.

The hospital is the largest in Delhi to have been recently empanelled under the scheme