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Hospitals found Indulging in Fraud in Ayushman Bharat will be Named and Shamed, Says Harsh Vardhan

Nearly 1,200 cases of fraud have been confirmed and action has been taken against 338 hospitals in the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana.

PTI

Updated:September 17, 2019, 8:53 PM IST
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Hospitals found Indulging in Fraud in Ayushman Bharat will be Named and Shamed, Says Harsh Vardhan
File photo of Union Minister Harsh Vardhan. (TV grab/ CNN-News18)

New Delhi: Union Health Minister Harsh Vardhan on Tuesday said the names of the hospitals found involved in any kind of fraudulent practices in the Ayushman Bharat health insurance scheme will be put up on its official website to "name and shame" them.

Nearly 1,200 cases of fraud have been confirmed and action has been taken against 338 hospitals in the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), Vardhan said.

Besides, 97 errant hospitals have been de-empanelled, FIRs have been lodged against six and penalties amounting to over Rs 1.5 crore have been levied, he told a press conference here, while asserting that the government has zero tolerance towards corruption.

The minister said a strong fraud prevention, detection and control system is proving to be critical for PMJAY to ensure that frauds are prevented and even if they are attempted, they are quickly detected and strong action is taken.

"Not only would such hospitals found involved in any kind of fraudulent activity and malpractices be de-empanelled, their names would be put up on the official website of the Pradhan Mantri Jan Arogya Yojana and made public. The idea is to name and shame them.

"The message is loud and clear that no fraud, even of a minute nature, will be tolerated in the whole scheme," the minister said as the health insurance scheme is set to complete a year on September 23.

Indu Bhushan, CEO of the National Health Authority (NHA), the apex body responsible for the implementation of the centrally-sponsored scheme, said the decision to publicly name the fraudsters under Ayushman Bharat was taken in collaboration with the IRDAI.

"In fact, we have suggested that such hospitals should not only be de-empanelled from PMJAY, but also from other schemes including the CGHS and the ECHA," he said.

Vardhan said 376 hospitals are under investigation, while the NHA has taken action in terms issuing show-cause notices, suspending, levying penalty and de-empanelling against 338 hospitals.

Also, 8,900 matters have been flagged as "suspected" cases of fraud under the transaction management systems shared with the states so far.

The health minister said recently, the governing board of the NHA decided to overhaul the existing health benefits packages and rationalise their costs to remove any aberrations.

This will ensure wider private sector participation by empanelling more hospitals to improve access to hospitalisation-related care, he added.

With the government's ambitious Ayushman Bharat scheme completing a year, Vardhan said the September 15-30 fortnight will be marked as the "Ayushman Bharat Pakhwara", where several activities will be carried out to raise awareness on the preventive, promotive and curative aspects of healthcare, nutrition, yoga and a healthy lifestyle.

Ayushman Bharat has two pillars the first is the AB-PMJAY that aims to cover over 10 crore poor and vulnerable families (approximately 50 crore beneficiaries), providing a coverage of up to Rs 5 lakh per family per year for secondary and tertiary hospitalisation.

The second pillar is that nearly 1.5 lakh sub-centres and primary health centres will be transformed as health and wellness centres by 2022 to provide a comprehensive and quality primary care close to the community, while ensuring the principles of equity, affordability and universality.

Adopting the true spirit of cooperative federalism, 32 states and Union territories have already implemented the scheme, Vardhan said and appealed to the remaining states, including Delhi and West Bengal, to join it.

Since the launch of PMJAY, more than 47 lakh hospital treatments worth over Rs 7,500 crore have been carried out. Of the total amount utilised, 55 per cent has been on tertiary procedures, Vardhan said.

In addition, over 10 crore beneficiary cards have been issued and the government has so far spent Rs 7,500 crore on treatment of patients under the scheme, he added.

As many as 18,073 hospitals and healthcare providers have been empanelled across the country and of these, 53 per cent are private, the minister said.

"A unique feature of PMJAY is its portability, which has helped the eligible poor and migrant workers to seek treatment outside their states. So far, there have been more than 40,000 portability cases," he informed.

A mega national event called the "Arogya Manthan" will be organised on September 30 and October 1, during which Prime Minister Narendra Modi will take stock of the insurance scheme's progress with all the states participating in a workshop, an official said.

Elaborating the benefits that have accrued from the health and wellness centres, Vardhan said over 1.5 crore people have been screened for hypertension and more than 70 lakh people put on treatment.

Around 1.3 crore people have been screened for diabetes and more than 31 lakh people are on treatment. Similarly, the suspected cases for the three common cancers (breast, cervix and oral) are referred to the higher public healthcare facilities for diagnosis and treatment.

While more than 53 lakh women have been screened for breast cancer and around 9,700 women are on treatment, over 37 lakh women have been screened for cervical cancer and around 10,000 are on treatment.

More than 1.6 crore people have been given medicines and around 49 lakh people provided diagnostic services, the minister said.

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