Prime Minister Narendra Modi’s Ayushman Bharat scheme, dubbed as the ‘world’s largest healthcare programme’ is full of anomalies, according to a report published in the Hindi daily Dainik Bhaskar on January 3. The report claimed that these anomalies, including issuance of over 2 lakh false Golden Cards, were found by the National Health Authority itself. While preliminary investigation by the Authority revealed huge inconsistencies in the number of beneficiaries availing services and the kind of services being availed, the report said that further investigation may reveal that the actual scenario is even worse.
The daily said that the highest number of anomalies under the scheme were found in the states of Uttar Pradesh, Gujarat, Chhattisgarh, Maharashtra, Haryana, Uttarakhand, and Jharkhand. In these states, cards have been issued to people who are not eligible to be beneficiaries of the Ayushman Bharat scheme. It said that the NHA also suspects that numerous private hospitals have been issuing false claims under the scheme. In the preliminary investigations, it was found that at least 67 hospitals have raised false claims. These hospitals had already been reimbursed by the government. Upon the discovery of false claims, these hospitals were slapped with huge monetary penalties. One hundred and seventy one hospitals have also been ousted from the scheme for making false bills.
The report also said that NHA has found that in one hospital in Gujarat, an Arogya Mitra issued 1,700 cards in the name of one family. Similarly, in Chhattisgarh109 cards were issued for one family, out of which 57 cards have already been used for cataract surgeries. In Punjab, 200 cards have been issued to two families. Some of these cards were issued to people who do not even hail from the state. In Madhya Pradesh, 322 cards were issued to one family.
The report pointed out more inconsistencies. In Jharkhand, one patient was shown to be admitted in two hospitals at the same time. When these two hospitals raised the claims, they were both reimbursed by the government. A similar case was seen in Chhattisgarh. In UP, a hospital changed the name of a procedure which is already free under government scheme and raised a claim for it.
This is not the first time disparities have been noticed in the Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB PM-JAY), PM Modi’s flagship scheme. In November 2019, a report published by the NHA revealed huge disparities between the number of claims raised by the government and private hospitals. Disparities were also found in between the costs of same procedures. It was seen that the private hospitals raised claims of higher amounts for same procedures when compared to the public hospitals. The report had found that out of the 49 lakh beneficiaries who utilised the benefits under the scheme, 33 lakh, that is, 63% of the claims were made in private hospitals, while the remaining 37% were made in public hospitals. Benefits worth Rs 3,767 crore, that is, 75% of the total cost of packages claimed by beneficiaries of the scheme, were utilised in private hospitals, while for government hospitals, this amount was Rs 1,237 crore (25%).
A paper published by a government authority had also revealed huge gaps in benefits utilised for neonatal care under the Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) in private and public hospitals across the country, according to a paper published by a government authority. The paper analysed the utilisation of neonatal care packages under PMJAY in the Greenfield states (states where there was no insurance scheme before the implementation of PMJAY) and found that a significant majority of claims are being raised by private hospitals in these states. The Greenfield states are Chhattisgarh, Jharkhand, Madhya Pradesh, Uttar Pradesh, Uttarakhand, Haryana, Meghalaya, Mizoram, Bihar, Jammu and Kashmir, Himachal Pradesh, Nagaland, and the Union Territory Dadra and Nagar Haveli.