Ayushman frauds pile up: How govt plans to tackle the menace

Government officials have lodged FIRs and slapped fines to the tune of Rs 1 crore on hospitals involved in frauds.

Since the launch of Ayushman Bharat - the flagship heath care programme of the Narendra Modi government - nine months back, most cases of fraud have been reported from Uttarakhand and Jharkhand.

As a result, the government has tightened a number of rules to prevent these.

The first case was lodged in Nainital. Since then, government officials have lodged first information reports (FIRs) and slapped fines to the tune of Rs 1 crore on hospitals involved in frauds.

A senior government official explained how some of these hospitals use loopholes in protocols.

“Hospitals need to get pre-authorisation within six hours of admitting and treating patients under the scheme,” he said.

“If the authority concerned does not approve within six hours, it is deemed to be approved and the hospital can go ahead with the treatment.”

The hospitals would deliberately send cases late at night when there would be no one to approve.

“Now, we have changed the rules so that regular requests will be entertained only between 10 am and 5 pm.

"At other times, only emergencies will be looked into,” the official added.

Sources in the government said they had also detected some unusual trends and were making protocols stringent.

One disease that has been used by fraudulent cases is enteric fever.

Observing that more than expected patients were being treated for it, the government has made Vidal tests mandatory for treating enteric fever.

Till July 4, 200,000 people have been verified for enteric fever by health authorities and Rs 4,000 crore has been pre-authorised for payout to beneficiaries.

Under this scheme, free health care is provide for up to Rs 500,000 per family, and provides treatment for 1,300 packages.

The rates for the packages were revised upwards after private hospitals felt these were not viable.

The scheme provides tertiary care to those who feature in the Socio-Economic Caste Census 2011.

Officials said 100 million families were eligible.

Benefits include hospitalisation expenses in the general ward, consultation fees, equipment and procedure charges, cost of consumables and tests, food for patients, and pre- and post-hospitalisation expenses.

The Ayushman Bharat scheme replaced the Rashtriya Swasthya Bima Yojana, which provided medical cover of up to Rs 30,000.

The government had initially planned to launch an insurance scheme before launching Ayushman Bharat.

Surgeries that often cost lakhs of rupees are conducted in thousands under the scheme.

Photograph: PTI Photo