171 hospitals de-listed from PM’s health scheme after fraud
Private institutions found conducting procedures reserved for govt. units
05/01/2020, BINDU SHAJAN PERAPPADAN ,NEW DELHI
The Centre’s ambitious healthcare insurance scheme — Pradhan Mantri Jan Arogya Yojana (PM-JAY) — under the National Health Authority (NHA) has noted that as per details provided by the States, more than 390 hospitals of the over 19,000 empanelled across nine States have been either served show cause notices, suspended, or de-empanelled, for alleged fraud.
Of these, 171 hospitals have been de-empanelled and FIRs have been lodged against six hospitals in Uttarakhand and Jharkhand. The quantum of penalties levied on the listed hospitals is more than ₹4.6 crore.
Fake beneficiaries
“Close watch is also maintained on wrongful enrolment of beneficiaries; 3,785 Village Level Entrepreneurs (positioned at Common Service Centres) / Pradhan Mantri Arogya Mitras (positioned at PM-JAY empanelled hospitals) have been deactivated so far,” a senior NHA official said on Saturday.
The official confirmed that the National Anti-Fraud Unit (NAFU) at the NHA has detected that the frauds, committed using e-cards on the basis of algorithms, developed internally.
The cover provided under the PM-JAY health insurance scheme is ₹5 lakh per family.
Abuse-prone packages
“There are certain packages which are reserved for government hospitals by the State authorities, and these are especially abuse prone. It was detected that private hospitals were performing these government-reserved procedures and blocking/submitting the same under a different package name or as a unspecified package. There is no package under the PM-JAY scheme which is free for government hospitals,” added the official.
However, the NHA maintained that responsibility for the closure action lies with the State health agencies.
Gujarat, Chhattisgarh, Madhya Pradesh and Punjab were among the States where frauds were detected at different stages of implementation of the PM-JAY.
“We have issued comprehensive set of anti-fraud guidelines from the time of launch of the scheme and as a safeguard, pre-authorisation is required for most packages ... All claims require mandatory supporting documents before approval and payment ... Almost all States have dedicated anti-fraud units now” the NHA official said.
Private institutions found conducting procedures reserved for govt. units
05/01/2020, BINDU SHAJAN PERAPPADAN ,NEW DELHI
The Centre’s ambitious healthcare insurance scheme — Pradhan Mantri Jan Arogya Yojana (PM-JAY) — under the National Health Authority (NHA) has noted that as per details provided by the States, more than 390 hospitals of the over 19,000 empanelled across nine States have been either served show cause notices, suspended, or de-empanelled, for alleged fraud.
Of these, 171 hospitals have been de-empanelled and FIRs have been lodged against six hospitals in Uttarakhand and Jharkhand. The quantum of penalties levied on the listed hospitals is more than ₹4.6 crore.
Fake beneficiaries
“Close watch is also maintained on wrongful enrolment of beneficiaries; 3,785 Village Level Entrepreneurs (positioned at Common Service Centres) / Pradhan Mantri Arogya Mitras (positioned at PM-JAY empanelled hospitals) have been deactivated so far,” a senior NHA official said on Saturday.
The official confirmed that the National Anti-Fraud Unit (NAFU) at the NHA has detected that the frauds, committed using e-cards on the basis of algorithms, developed internally.
The cover provided under the PM-JAY health insurance scheme is ₹5 lakh per family.
Abuse-prone packages
“There are certain packages which are reserved for government hospitals by the State authorities, and these are especially abuse prone. It was detected that private hospitals were performing these government-reserved procedures and blocking/submitting the same under a different package name or as a unspecified package. There is no package under the PM-JAY scheme which is free for government hospitals,” added the official.
However, the NHA maintained that responsibility for the closure action lies with the State health agencies.
Gujarat, Chhattisgarh, Madhya Pradesh and Punjab were among the States where frauds were detected at different stages of implementation of the PM-JAY.
“We have issued comprehensive set of anti-fraud guidelines from the time of launch of the scheme and as a safeguard, pre-authorisation is required for most packages ... All claims require mandatory supporting documents before approval and payment ... Almost all States have dedicated anti-fraud units now” the NHA official said.
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