The Union Government admitted that some private hospitals across the country were involved in creating fake Ayushman Bharat AB-PMJAY ID cards and claimed money in exchange for treating patients with these cards.
Union Minister of State for Health, Prataprao Jadhav informed the Lok Sabha that the Directorate of Enforcement (ED) conducted searches at 20 locations in a case related to the alleged generation of fake Ayushman Bharat- Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) cards. The locations searched included seven hospitals and their key management persons.
The searches were conducted in Delhi, Chandigarh, Punjab, and Himachal Pradesh against Shree Banke Bihari Hospital, Fortis Hospital Himachal Healthcare Private Limited, City Super Speciality Hospital, Shri Balaji Hospital, Shri Harihar Hospital, Sood Nursing Home, Neelkanth Hospital for collection of the evidence of the offense of money-laundering.
“The search operations led to the seizure of cash amounting to approximately Rs. 88 lakh and various incriminating documents and digital devices”, the Minister said.
“Further, three cases pertaining to forged claims by hospitals empaneled under AB-PMJAY in Assam have been recorded by the Directorate of Enforcement”, the Minister said.
Reimbursements were made on fake Ayushman Cards
Important to mention here that during the investigation the ED detected as many as fake Ayushman Cards wherein claims of about Rs.40.68 lakh were made for reimbursement from the government in the name of treatments given to the said Ayushman Card beneficiaries.
During verifications, some beneficiaries even denied possession or any information of any such PMJAY Card. Further, they never underwent any such treatment in any of these hospitals. Apart from this, hospitals have made claims for treatments/surgery/admission which were actually never given/done to the patients.
As per the investigation conducted so far, the case involves Proceeds of Crime (PoC) of about Rs. 25 crore. ED searches led to the discovery of cash of Rs. 88 lakh, four bank lockers, and 140 related bank accounts.
Hospitals cannot deny treatment to eligible beneficiaries under Ayushman Card
The Minister said that under Ayushman Bharat– Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), as per the terms and conditions of empanelment, hospitals cannot deny treatment to eligible beneficiaries of the scheme.
“In case of denial of treatment by the empaneled hospital, beneficiaries can lodge grievances. Under AB-PMJAY, a three-tier grievance redressal system at the district, state, and national levels has been created to resolve the issues faced by beneficiaries in utilizing healthcare services.
“At each level, there is a dedicated nodal officer and grievance redressal committees to address the grievances. Beneficiaries can file their grievances using different mediums including the web-based portal Centralized Grievance Redressal Management System (CGRMS), Central and State call centers (14555), email, letters to State Health Agencies (SHAs), etc”, the Minister said.
“Based on the nature of the grievance, necessary action including providing support to the beneficiaries in availing treatment under the scheme is taken”, the Minister said, adding, “Further, in appropriate cases, provisions for taking stringent action (such as de-empanelment, levying penalty on errant hospitals, suspension, issuance of the warning letter, lodging of FIRs) are available to the State Health Authorities against fraudulent entities”.
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