171 hospitals de-empanlled with penalty Rs 4.6 crore for committing fraud in PMJAY.
The National Health Authority (NHA) has said that 171 hospitals de-empanelled about with penalty Rs 4.6 crore in nine states for indulging in fraudulent activities in the Govt’s health insurance scheme: Ayushman Bharat– Pradhan Mantri Jan Arogya Yojana (AB-PMJAY).
Moreover, more than 390 hospitals have been served show-cause notice and suspended in different states.
The National Anti-Fraud Unit (NAFU) at NHA has pointed out that several cases of malpractices among empanelled hospitals.
These malpractices have largely occurred in hospitals based in Gujarat, Chhattisgarh, Madhya Pradesh and Punjab.
“Soon after getting the tipoff, the State Health Agency was alerted which disabled cards, FIR was also lodged and show cause notice was issued to the hospitals.
The penalty has also been levied on TPA,” said a senior official at NHA.
Penalties to the tune of more than Rs 4.5 crores have also been levied on hospitals indulging in malpractices, he added.
A close watch is also maintained on wrongful enrolment of beneficiaries under the scheme.
“About 3,785 village-level entrepreneurs who are positioned at common service centres and Pradhan Mantri Arogya Mitras positioned at PMJAY empanelled hospital have been deactivated so far,” stated the official.
“There are certain packages, which are reserved for government hospitals by the state authorities.
It was detected that private hospitals were performing these government reserved procedures and blocking and submitting the same under a different package name or as an unspecified package.”
Ayushman Bharat- PMJAY is the world’s biggest healthcare scheme, it aims to cover over 10 crore poor and vulnerable families (approximately 50 crore beneficiaries) providing coverage upto 5 lakh rupees per family per year for secondary and tertiary care hospitalization.