PunjabVigilance Bureau has exposed a big scam worth crores of rupees under thePradhan Mantri Jan Arogya Yojana - 'Aushmaan Bharat' scheme in which privatehospitals have obtained health insurance claims from insurance company namedIFFCO TOKIO on the basis of fake bills for treatment of beneficiary patientspossessing smart health cards. Contrary to this, the IFFCO TOKIO had rejectedhundreds of insurance claims pertaining to government hospitals causing a hugeloss to the state exchequer.
Disclosingthis here today, DGP-cum-Chief Director Vigilance Bureau BK Uppal said on thebasis of inputs received from credible sources, it has came to light thatseveral well known private hospitals based in Jalandhar, Hoshiarpur andKapurthala districts have prepared hefty fake bills on the names of smart cardholders for their treatment under Ayushman Bharat scheme and took insuranceclaims from IFFCO TOKIO. "A regular vigilance enquiry has been registeredby the bureau to investigate this scam worth crores of rupees in thestate", he added.
Givingdetails of the preliminary findings he informed that SSP vigilance rangeJalandhar Daljinder Singh Dhillon have unearthed this fraud in which severalfake medical bills of private hospitals had been cleared by the insurancecompany but on the contrary reimbursement bills forwarded by governmenthospitals were rejected. In this connection, major negligence has been seen atthe end of concerned Deputy Medical Commissioners and doctors of statehospitals/primary health centres.
"Themajor reason for rejecting the insurance claims of government hospitals by thecompany was to get extraordinary financial benefits. Rs 52, 06,500 (Fifty twolacs six thousand five hundred rupess). As a result, the Punjab government hasincurred a total financial loss of to the state exchequer during the last oneyear from these three aforesaid districts", said Uppal.
Duringinvestigations it has came to light that a well known hospital of SultanpurLodhi town in Kapurthala district had claimed Rs. 4,43,98,450/- (Four croreforty three lacs ninety eight thousand four hundred fifty rupess) for thetreatment of about 1,282 patients and out of which 519 claims have beenrejected. On the basis of these medical bills, State Health Authority, Punjabhave passed claims of this hospital to the tune of Rs. 4,23,48,050 (Four croretwenty three lacs forty eight thousand fifty rupess). Then IFFCO TOKIOinsurance company reimbursed the claimed amount to the tune of Rs. 1,86,59,150(One crore eighty six lacs fifty nine thousand one hundred fifty) out of Rs.4,43,98,450 to the said hospital.
Revealingthe modus operandi by the administration of hospital under investigation (Namewithheld not to hamper investigations), vigilance chief further informed that apatient named Paramjeet Kaur village Turna in Jalandhar district was admittedto the hospital for operating gall bladder stone but due to her personalreasons she did not undergo the operation. In this regard, the hospitalprepared a fake medical bill of Rs. 22,000 for this patient and tookreimbursement claim form IFFCO TOKIO under the Ayushman Bharat health insurancescheme.
Furthermore,Uppal disclosed that in another such case patient Sukhjinder Kaur villageSidhupur was admitted to the same hospital for gall bladder operation. Shepresented her smart health card issued by the Punjab government but thedirector of this hospital asked the patient that her treatment could not bedone with one smart card. In this connection, the hospital director told thepatient to either deposit Rs. 25,000 in cash or bring 6/7 smart cards to availthe benefit of treatment. After this Sukhjinder Kaur’s family submitted threesmart cards belonging to her family members to the hospital while facingunder-compulsion.
Hesaid that to cover up the fraud, this hospital has shoot fake videos ofSukhjinder Kaur’s family members by lying them on the hospital beds and tooktheir signatures on blank papers. The administrator of hospital had instructedthem to reply on receiving a phone call by saying that they underwent anoperation. But all three of them had no ailment. The hospital claimed falselyRs 25,000 each of three persons for operating only Sukhjinder Kaur. This raisedthe suspicion that the Ayushman Bharat scheme was being rigged on a large scaleby this hospital.
Inthis regard, information gathered by VB Jalandhar Range, reveals that severalreputed private hospitals based in Jalandhar, Kapurthala and Hoshiarpur haveobtained the insurance claims by fabricating huge medical bills in the names ofsmart health card holders. A total of 35 government and 77 private hospitalshave been listed by the Punjab government under this scheme in these threeaforesaid districts.
Accordingto reliable input and figures 4828 claims of 77 private hospitals were rejectedduring last one year by the IFFCO TOKIO health insurance company. The amount ofrejected insurance claims of private hospitals is approximately 5,59,96,407(Five crores fifty nine lacs ninety six thousand four hundred sever rupees).
Abovethis, it is also reliably learnt that 1,015 claims of 35 government hospitalswere rejected during last one year by the IFFCO TOKIO. The amount of rejectedinsurance claims of government hospitals is approximately 52, 06,500 (Fifty twolacks six thousand five hundred rupees).
Uppaladded that a vigilance enquiry has been registered to probe this scam in depthand to expose the irregularities being committed by the private hospitals inthe state for achieving massive financial gains.
Itis pertinent to mention here that this health insurance scheme is being run inthe state of Punjab under Sarbat Health insurance scheme. According to thisscheme, 40% premium share as a financial assistance is being paid by Punjabgovernment and the remaining share 60% is contributed by central government tothe IFFCO TOKIO under this scheme.
Anamount of Rs. 1000 is being paidannually by the government as premium per family to the IFFCO TOKIO. In thisregard, the Punjab Government also issues smart health cards to the poor andunderprivileged families. Through this smart card if any beneficiary or hisfamily member gets any serious illness, he/she could be admitted to the listedhospitals under this scheme and avail free cashless treatment upto Rs. 5 lakhs.