Big Fraud! Pvt Hospitals in Madhya Pradesh misused PM Ayushman Yojana and claimed money for dead patients

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A serious case of cheating has come to light in Madhya Pradesh (MP) related to a healthcare program called the Pradhan Mantri Ayushman Card Yojana. This program is meant to help people get medical treatment when they need it. But in this case, a private hospital did something very wrong. They tricked the system by giving treatment to people who were not alive anymore, and then they pretended to treat them again.

This dishonest behavior was uncovered when a report from a government watchdog called the Comptroller and Auditor General (CAG) came out. This report showed that some private hospitals in MP, which were supposed to have space for 100 beds, were actually saying they had treated 230 patients.

This is a big difference! Even more shockingly, the report found that these hospitals claimed money for treating 447 patients who had not even been admitted to the hospital. This false claim added up to Rs 1.2 crore. But the dishonesty didn’t stop there. The report also found that some patients were said to be getting treatment in more than one hospital at the same time. This means they were being counted twice, which is not fair. Around 8081 patients were affected by this double-counting trick, and it involved 213 hospitals.

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The CAG report pointed out that in MP, about 25 hospitals were pretending to have more patients than they could actually handle. This allowed them to make false claims for more money. For example, a hospital with 100 beds said they were treating 233 patients when they weren’t. The report also talked about how many hospitals, a total of 24, including both government and private ones, were part of this dishonest behavior.

The CAG report criticized MP for not being able to recover the money from these dishonest hospitals. This means they couldn’t get back the money that was wrongly taken. In fact, almost 96 percent of the cheating money has not been returned in MP. This is a big problem. Interestingly, Madhya Pradesh has the most number of people in India who have cards for this Ayushman program. This is why these problems are a big concern in MP.

The report also showed that MP had the most problems when compared to other states. The report also found that MP did not set up groups to solve problems for patients at the district level. This was something they were supposed to do. Additionally, plans to educate people about the program were made, but they were not carried out.

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So, in simple terms, some hospitals in Madhya Pradesh cheated by saying they treated more patients than they really did, including patients who were no longer alive. This report tells us that this problem is a big one in Madhya Pradesh and needs to be fixed.

The Comptroller-Auditor General of India (CAG) has revealed that nearly 7.5 lakh beneficiaries registered under the Ayushman Bharat — Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) were linked with a single mobile number — 9999999999.

“Data analysis of the BIS database revealed that there were large numbers of beneficiaries registered against the same or invalid mobile number. Overall, 1119 to 7,49,820 beneficiaries were linked with a single mobile number in the BIS database…,” the report stated.

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The report titled “Performance Audit of Ayushman Bharat” observed that states such as Chhattisgarh, Haryana, Jharkhand, Kerala and Madhya Pradesh have reported the maximum number of such cases.

Pointing out that the same patients got admission to multiple hospitals during the same period of hospitalisation, CAG in its report said that there was no mechanism to prevent such malpractice.

“Data analysis of mortality cases in TMS revealed that 88,760 patients died during treatment specified under the Scheme. A total of 2,14,923 claims are shown as paid in the system, related to fresh treatment in respect of these patients. The audit further noted that in 3,903 of the above claims amounting to Rs 6.97 crore pertaining to 3,446 patients were paid to hospitals,” the report reads.

Highlighting the unrealistic household size for registered beneficiaries under PMJAY, the CAG report said, Data analysis revealed that in 43,197 households, the size of the family was unrealistic, ranging from 11 to 201 members…” the report noted.

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