Over 300 hospitals get show-cause notices for submitting forged claims under AB-PMJAY

Over 300 hospitals have been served show-cause notices and de-empanelled, and penalties of over Rs 3 crore have been levied on them for submitting forged claims under the Ayushman Bharat Health Insurance Scheme, the government told Rajya Sabha on Tuesday. Some instances of creation of fake cards and submission of manipulated/forged claims under the Ayushman Bharat  Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) have come to the notice, Minister of State for Health Ashwini Choubey said.

These instances, he said, have been suitably dealt with by the respective state governments. "More than 338 hospitals have been served show-cause notice/suspended/de-empanelled in different states and penalties of over Rs 3 crore have been levied on errant hospitals so far," he said. Also, a close watch is maintained on wrongful enrolments of beneficiaries and 3,785 common service centres and 'Pradhan Mantri Arogya Mitra' IDs have been deactivated in 21 states, he added.

On actions taken by Centre to prevent abuse of schemes

Elaborating the actions taken by the Centre to prevent abuse of the scheme in hospitals, Choubey said a vigil is being maintained on the utilisation of data through real-time dashboards to identify suspect cases for over utilisation. Suspect cases and entities are flagged based on different fraud control triggers and results are shared with state agencies for further investigation. Besides, regular joint medical audits along with state anti-fraud units (SAFU) of hospitals, both random and purposive, are conducted to identify any wrongdoing, he said.

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All admissions under the AB-PMJAY require pre-authorisations from respective state health agencies and a comprehensive set of anti-fraud guidelines have been issued from the time of launch of the scheme, the minister said. Regular anti-fraud advisory notes are issued to all states advising them on measures to be adopted to prevent, detect and deter fraud, he said. Packages prone to fraud and abuse are reserved for public hospitals or need mandatory pre-authorization and require detailed documentation before claims are paid. 

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